Provider Demographics
NPI:1447221510
Name:MARTENS, MARK GORDEN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:GORDEN
Last Name:MARTENS
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:PO BOX 16052
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19612-6052
Mailing Address - Country:US
Mailing Address - Phone:484-628-8333
Mailing Address - Fax:484-628-8334
Practice Address - Street 1:420 S 5TH AVE
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19611-2143
Practice Address - Country:US
Practice Address - Phone:484-628-8333
Practice Address - Fax:484-628-8334
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD464152207V00000X
NJ25MA08692100207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ176793UUGMedicare PIN
NJC18828Medicare UPIN