Provider Demographics
NPI:1386663003
Name:MARTIN, KRISTEN HEDGER (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:HEDGER
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:711 TROY SCHENECTADY RD STE 203
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2461
Mailing Address - Country:US
Mailing Address - Phone:518-782-3700
Mailing Address - Fax:518-782-3799
Practice Address - Street 1:286 STAGE RD
Practice Address - Street 2:
Practice Address - City:CHARLTON
Practice Address - State:NY
Practice Address - Zip Code:12019-2619
Practice Address - Country:US
Practice Address - Phone:518-399-2101
Practice Address - Fax:518-399-2130
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY231262207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000416463001OtherBSNENY
NY10084510OtherCDPHP
NY7415613OtherAETNA
NY371498OtherMVP
NY81879OtherGHI/HMO
NY02563275Medicaid
NY070216000062OtherFIDELIS
NY1864R1OtherEMPIRE BC
NY200100OtherSENIOR WHOLE HEALTH
NY070216000062OtherFIDELIS
NY81879OtherGHI/HMO