Provider Demographics
NPI:1750300778
Name:GEORGE L MARTIN MD PC
Entity Type:Organization
Organization Name:GEORGE L MARTIN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-649-9300
Mailing Address - Street 1:100 E LANCASTER AVE
Mailing Address - Street 2:SUITE 237 WEST LANKENAU MEDICAL BUILDING
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-3450
Mailing Address - Country:US
Mailing Address - Phone:610-649-9300
Mailing Address - Fax:610-896-4617
Practice Address - Street 1:100 E LANCASTER AVE
Practice Address - Street 2:SUITE 237 WEST LANKENAU MEDICAL BUILDING
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3450
Practice Address - Country:US
Practice Address - Phone:610-649-9300
Practice Address - Fax:610-896-4617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & ImmunologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA525041Medicare ID - Type Unspecified