Provider Demographics
NPI:1558668608
Name:WASSERMAN, MARTIN PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:PAUL
Last Name:WASSERMAN
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 1:13200 TRIADELPHIA RD
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-1143
Mailing Address - Country:US
Mailing Address - Phone:301-854-0023
Mailing Address - Fax:
Practice Address - Street 1:13200 TRIADELPHIA RD
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-1143
Practice Address - Country:US
Practice Address - Phone:301-854-0023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-24
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD 11659208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics