Provider Demographics
NPI:1750329918
Name:MARTIN, GARY L (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:L
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:PO BOX 829
Mailing Address - Street 2:
Mailing Address - City:HILDEBRAN
Mailing Address - State:NC
Mailing Address - Zip Code:28637-0829
Mailing Address - Country:US
Mailing Address - Phone:828-397-3522
Mailing Address - Fax:828-397-3522
Practice Address - Street 1:107 S CENTER ST
Practice Address - Street 2:
Practice Address - City:HILDEBRAN
Practice Address - State:NC
Practice Address - Zip Code:28637-8304
Practice Address - Country:US
Practice Address - Phone:828-397-3522
Practice Address - Fax:828-397-3522
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101059276207Q00000X
NC138795207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5906347Medicaid
NC144NWOtherBCBS
NC5743081OtherCIGNA
NC2065737Medicare PIN