Provider Demographics
NPI:1700036951
Name:MARTIN PRIMARY CARE LLC
Entity Type:Organization
Organization Name:MARTIN PRIMARY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:AHMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:FADEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-287-9143
Mailing Address - Street 1:3257 SE SALERNO RD
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-6736
Mailing Address - Country:US
Mailing Address - Phone:772-287-9144
Mailing Address - Fax:
Practice Address - Street 1:3257 SE SALERNO RD
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-6736
Practice Address - Country:US
Practice Address - Phone:772-287-9144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-24
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 85669207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty