Provider Demographics
NPI:1588660542
Name:MARTIN, STEPHEN S (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:S
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MD, PHD
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 785
Mailing Address - Street 2:
Mailing Address - City:PRESQUE ISLE
Mailing Address - State:ME
Mailing Address - Zip Code:04769-0785
Mailing Address - Country:US
Mailing Address - Phone:207-764-7900
Mailing Address - Fax:207-764-7979
Practice Address - Street 1:146 ACADEMY ST
Practice Address - Street 2:STE D
Practice Address - City:PRESQUE ISLE
Practice Address - State:ME
Practice Address - Zip Code:04769-3102
Practice Address - Country:US
Practice Address - Phone:207-764-7900
Practice Address - Fax:207-764-7979
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-24
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME012052207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME126430000Medicaid
MEMM2414Medicare ID - Type Unspecified
ME126430000Medicaid