Provider Demographics
NPI:1457324550
Name:MARTYN, JOSEPH JEEVENDRA A. (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH JEEVENDRA A.
Middle Name:
Last Name:MARTYN
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 9142
Mailing Address - Street 2:
Mailing Address - City:CHARLSTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-726-8807
Mailing Address - Fax:617-371-4821
Practice Address - Street 1:51 BLOSSOM ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2601
Practice Address - Country:US
Practice Address - Phone:617-726-8807
Practice Address - Fax:617-371-4821
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA38948207L00000X, 207LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ02457OtherBCBS MA
MA2095637Medicaid
MA712508OtherTUFTS HEALTH PLAN
MAJ02457OtherBCBS MA
B96406Medicare UPIN