Provider Demographics
NPI:1518195734
Name:SMITH, MARTIN ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:ALLEN
Last Name:SMITH
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 1:1670 DRY DOCK AVE
Mailing Address - Street 2:BUILDING 10
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29405-2114
Mailing Address - Country:US
Mailing Address - Phone:843-747-3526
Mailing Address - Fax:
Practice Address - Street 1:1670 DRYDOCK AVE
Practice Address - Street 2:BUILDING 10
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405
Practice Address - Country:US
Practice Address - Phone:843-747-3526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-25
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL31900207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine