Provider Demographics
NPI:1568531010
Name:MARTIN, ADRIAN P (MD)
Entity Type:Individual
Prefix:MR
First Name:ADRIAN
Middle Name:P
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:PO BOX 3988
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62902-3988
Mailing Address - Country:US
Mailing Address - Phone:618-457-5200
Mailing Address - Fax:
Practice Address - Street 1:305 W JACKSON ST STE 206
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-1474
Practice Address - Country:US
Practice Address - Phone:618-457-3006
Practice Address - Fax:618-457-3008
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-115702208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL120857OtherHEALTH ALLIANCE
IL324137OtherGHP
IL036115702Medicaid
IL3932056OtherBCBS OF IL
IL7210895OtherAETNA
IL294010OtherHEALTHLINK
ILK45550Medicare PIN
IL036115702Medicaid
IL7210895OtherAETNA
IL324137OtherGHP
IL614350Medicare ID - Type UnspecifiedMEDICARE GROUP #