Provider Demographics
NPI:1609862150
Name:GAVIN, MARTIN F (DO)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:F
Last Name:GAVIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4923 OGLETOWN STANTON RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2081
Mailing Address - Country:US
Mailing Address - Phone:302-225-0451
Mailing Address - Fax:302-225-0472
Practice Address - Street 1:137 W HIGH ST
Practice Address - Street 2:SUITE 1A
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-8604
Practice Address - Country:US
Practice Address - Phone:410-620-9200
Practice Address - Fax:410-620-9207
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0037636207RN0300X
DEC2-0002985207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8818100Medicaid
MD52681600Medicaid
DE0000087903Medicaid
MD036M795EMedicare PIN
MD52681600Medicaid
C48750Medicare UPIN