Provider Demographics
NPI:1417251489
Name:MARTIN, PATRICK THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:THOMAS
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 1:213 PLYMOUTH ROAD
Mailing Address - Street 2:BOX 593
Mailing Address - City:GWYNEDD VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19437
Mailing Address - Country:US
Mailing Address - Phone:215-540-1249
Mailing Address - Fax:
Practice Address - Street 1:213 PLYMOUTH ROAD
Practice Address - Street 2:
Practice Address - City:GWYNEDD VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19437
Practice Address - Country:US
Practice Address - Phone:215-540-1249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-05
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD055258L208000000X, 208U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208U00000XAllopathic & Osteopathic PhysiciansClinical Pharmacology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics