Provider Demographics
NPI:1417946922
Name:MARTIN, MARTIN S (MD)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:S
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 1:2341 MCCALLIE AVE
Mailing Address - Street 2:PLAZA 3 SUITE 200
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-3239
Mailing Address - Country:US
Mailing Address - Phone:423-629-4106
Mailing Address - Fax:423-629-4116
Practice Address - Street 1:935 SPRING CREEK RD
Practice Address - Street 2:STE. 100
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37412-3993
Practice Address - Country:US
Practice Address - Phone:423-629-4106
Practice Address - Fax:423-629-4116
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN24604207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNE66874Medicare UPIN
GA06BDHQSMedicare PIN
TN3896842Medicare PIN
TNP00160357Medicare PIN