Provider Demographics
NPI:1407896608
Name:MARTIN, JOANNE CLEMENTINE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOANNE
Middle Name:CLEMENTINE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:457 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-6453
Mailing Address - Country:US
Mailing Address - Phone:973-540-1128
Mailing Address - Fax:973-984-0416
Practice Address - Street 1:457 SOUTH ST
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-6453
Practice Address - Country:US
Practice Address - Phone:973-540-1128
Practice Address - Fax:973-984-0416
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA31423207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0758604Medicaid
NJD06223Medicare UPIN
NJ0758604Medicaid