Provider Demographics
NPI:1659345494
Name:MARTIN, JAMES THOMAS JR (MD)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:THOMAS
Last Name:MARTIN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:9213 UNIVERSITY BLVD STE A
Mailing Address - Street 2:TRIDENT EXECUTIVE VILLAGE
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9145
Mailing Address - Country:US
Mailing Address - Phone:843-572-7123
Mailing Address - Fax:843-572-7350
Practice Address - Street 1:9213 A. UNIVERSITY BLVD.
Practice Address - Street 2:TRIDENT EXECUTIVE VILLAGE
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9145
Practice Address - Country:US
Practice Address - Phone:843-572-7123
Practice Address - Fax:843-572-7350
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-16
Last Update Date:2017-06-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC9818207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1679524888OtherNPI
SC098183Medicaid
SCGP4430 (474430)Medicaid
SC8521Medicare PIN
SC1679524888OtherNPI
SCD90556Medicare UPIN