Provider Demographics
NPI:1376607168
Name:MARTIN, MICHAEL RICHARD (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:RICHARD
Last Name:MARTIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4 DOGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COVENTRY
Mailing Address - State:RI
Mailing Address - Zip Code:02816-6650
Mailing Address - Country:US
Mailing Address - Phone:401-821-7870
Mailing Address - Fax:
Practice Address - Street 1:215 TOLL GATE RD
Practice Address - Street 2:SUITE 306
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-4458
Practice Address - Country:US
Practice Address - Phone:401-738-6565
Practice Address - Fax:401-738-6599
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI00512207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIH20763Medicare UPIN