Provider Demographics
NPI:1497799886
Name:MARTIN, ANDREW S (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:S
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2415 N ORANGE AVE
Mailing Address - Street 2:SUITE 502
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-5505
Mailing Address - Country:US
Mailing Address - Phone:407-303-2801
Mailing Address - Fax:407-303-2805
Practice Address - Street 1:2415 N ORANGE AVE
Practice Address - Street 2:SUITE 502
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-5505
Practice Address - Country:US
Practice Address - Phone:407-303-2801
Practice Address - Fax:407-303-2805
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME76895207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
990014992OtherRAILROAD MEDICARE
FL257861100Medicaid
FL49148OtherBCBS
FL49148OtherBCBS
FL49148ZMedicare PIN