Provider Demographics
NPI:1427395300
Name:MARTI, GERALD (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:
Last Name:MARTI
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11523 GAINSBOROUGH RD
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-3717
Mailing Address - Country:US
Mailing Address - Phone:301-706-4399
Mailing Address - Fax:
Practice Address - Street 1:11523 GAINSBOROUGH RD
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-3717
Practice Address - Country:US
Practice Address - Phone:301-706-4399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-11
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0025897207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1064403OtherMD STATE MEDICAL LICENCE