Provider Demographics
NPI:1548225113
Name:MARTIN, RICHARD T (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:T
Last Name: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 1:280 CHESTNUT ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01199-1001
Mailing Address - Country:US
Mailing Address - Phone:413-794-5700
Mailing Address - Fax:
Practice Address - Street 1:2 MEDICAL CENTER DR
Practice Address - Street 2:STE 309
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1270
Practice Address - Country:US
Practice Address - Phone:413-794-5363
Practice Address - Fax:413-794-4520
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA224087208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
36375OtherHNE
MAJ28981OtherBCBS OF MA PPO
J28981OtherBCBS OUT OF STATE
SS34124OtherHARVARD PILGRIM
042490038OtherAETNA
042490038OtherCBA PIONEER HLTH
MAJ28981OtherBCBS OF MA HMO
042490038OtherHEALTHCARE VALUE
042490038OtherPIONEER HEALTHCARE
224087OtherCONNECTICARE
042490038OtherUNITED HEALTHCARE
470340OtherTUFTS
000000030891OtherBOSTON HEALTHNET
042490038OtherCBA PIONEER HLTH
J28981OtherBCBS OUT OF STATE
470340OtherTUFTS