Provider Demographics
NPI:1497791081
Name:FLETCHER, MARTIN EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:EDWARD
Last Name:FLETCHER
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 1:300 OLD COUNTRY RD
Mailing Address - Street 2:SUITE GL-51
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-4198
Mailing Address - Country:US
Mailing Address - Phone:516-294-9300
Mailing Address - Fax:516-294-3407
Practice Address - Street 1:300 OLD COUNTRY RD
Practice Address - Street 2:SUITE GL-51
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-4198
Practice Address - Country:US
Practice Address - Phone:516-294-9300
Practice Address - Fax:516-294-3407
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY144623-1207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01180010Medicaid
NYA63460Medicare UPIN
NY61D051Medicare ID - Type Unspecified