Provider Demographics
NPI:1376559906
Name:MARTIN, THOMAS J (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1185 N 1000 W
Mailing Address - Street 2:
Mailing Address - City:LINTON
Mailing Address - State:IN
Mailing Address - Zip Code:47441-5282
Mailing Address - Country:US
Mailing Address - Phone:812-847-5212
Mailing Address - Fax:
Practice Address - Street 1:102 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:IN
Practice Address - Zip Code:47471-1603
Practice Address - Country:US
Practice Address - Phone:812-847-4481
Practice Address - Fax:844-658-7526
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01037295207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100186620BMedicaid
IN000000087924OtherANTHEM PIN
080058809OtherRAILROAD MEDICARE PROVID
INE26971Medicare UPIN
080058809OtherRAILROAD MEDICARE PROVID