Provider Demographics
NPI:1659431377
Name:ROBERT G. MARTIN
Entity Type:Organization
Organization Name:ROBERT G. MARTIN
Other - Org Name:MARTIN & ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:G
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:304-824-7776
Mailing Address - Street 1:8150 A COURT AVE.
Mailing Address - Street 2:
Mailing Address - City:HAMLIN
Mailing Address - State:WV
Mailing Address - Zip Code:25523-1434
Mailing Address - Country:US
Mailing Address - Phone:304-824-7776
Mailing Address - Fax:304-824-7776
Practice Address - Street 1:8150 A COURT AVE.
Practice Address - Street 2:
Practice Address - City:HAMLIN
Practice Address - State:WV
Practice Address - Zip Code:25523-1434
Practice Address - Country:US
Practice Address - Phone:304-824-7776
Practice Address - Fax:304-824-7776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV366103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001720515OtherBLUE CROSS BLUE SHIELD
WV3810002105Medicaid
WVMACP28521Medicare ID - Type Unspecified
WV3810002105Medicaid