Provider Demographics
NPI:1366493447
Name:MARTIN, LINDA D (MD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:D
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:432 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19123-4004
Mailing Address - Country:US
Mailing Address - Phone:215-925-2400
Mailing Address - Fax:215-925-9162
Practice Address - Street 1:1408 S BROAD ST FL 2
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19146-4808
Practice Address - Country:US
Practice Address - Phone:215-755-0700
Practice Address - Fax:215-755-6474
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD023560E208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0055554000OtherINDEPENDENCE CROSS
PA0008001670002Medicaid
PA04107410OtherAETNA
PA04107410OtherAETNA
PA04107410OtherAETNA
PA116517KWGMedicare ID - Type Unspecified