Provider Demographics
NPI:1518926849
Name:ST MARTIN, DORIAN S (MD)
Entity Type:Individual
Prefix:
First Name:DORIAN
Middle Name:S
Last Name:ST MARTIN
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 1:700 GEIPE RD
Mailing Address - Street 2:SUITE 275
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4147
Mailing Address - Country:US
Mailing Address - Phone:443-636-3100
Mailing Address - Fax:443-636-3101
Practice Address - Street 1:700 GEIPE RD
Practice Address - Street 2:SUITE 275
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21228-4147
Practice Address - Country:US
Practice Address - Phone:443-636-3100
Practice Address - Fax:443-636-3101
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2011-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0028236207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD374251200Medicaid
MDKV0842140102OtherCAREFIRST
DCW6200005OtherCAREFIRST
MDKV0842140102OtherCAREFIRST
DCW6200005OtherCAREFIRST