Provider Demographics
NPI:1598767816
Name:MARTIN, DANIEL S (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:S
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 1:9 N BROOKSIDE RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:19064-2527
Mailing Address - Country:US
Mailing Address - Phone:610-543-5400
Mailing Address - Fax:610-543-3124
Practice Address - Street 1:9 N BROOKSIDE RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:PA
Practice Address - Zip Code:19064-2527
Practice Address - Country:US
Practice Address - Phone:610-543-5300
Practice Address - Fax:610-543-3124
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD417368207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
080189416OtherRAILROAD MEDICARE
PA0018278900005Medicaid
PA0018278900005Medicaid