Provider Demographics
NPI:1679641385
Name:STEIN, MARTIN T (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:T
Last Name:STEIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9500 GILMAN DRIVE
Mailing Address - Street 2:MC 8464
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92093-8464
Mailing Address - Country:US
Mailing Address - Phone:619-657-8340
Mailing Address - Fax:619-543-2010
Practice Address - Street 1:7910 FROST ST
Practice Address - Street 2:SUITE 350
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2771
Practice Address - Country:US
Practice Address - Phone:858-496-4800
Practice Address - Fax:858-496-4850
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2011-02-18
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Provider Licenses
StateLicense IDTaxonomies
CAA23490208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A234900Medicaid
E54046Medicare UPIN
CA00A234900Medicaid