Provider Demographics
NPI:1710070792
Name:MARTIN, JAMES T (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:T
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 WOODCREST DR
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-3633
Mailing Address - Country:US
Mailing Address - Phone:304-250-0272
Mailing Address - Fax:304-250-0275
Practice Address - Street 1:201 WOODCREST DR
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-3633
Practice Address - Country:US
Practice Address - Phone:304-250-0272
Practice Address - Fax:304-250-0275
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV12395207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0052272000Medicaid
288990OtherUNITEDHEALTHCARE
WVA12395Medicaid
WV55853Medicaid
E52170OtherHEALTH NET
205835OtherCARELINK
WVMA2026316Medicare ID - Type Unspecified
E52170Medicare UPIN
WVE52170Medicare ID - Type UnspecifiedUGS MEDICARE