Provider Demographics
NPI:1790871648
Name:HRYNICK, MARTIN J (MD)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:J
Last Name:HRYNICK
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 1820
Mailing Address - Street 2:
Mailing Address - City:PRESQUE ISLE
Mailing Address - State:ME
Mailing Address - Zip Code:04769-1820
Mailing Address - Country:US
Mailing Address - Phone:207-764-7529
Mailing Address - Fax:207-764-6504
Practice Address - Street 1:226 MAIN ST
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:ME
Practice Address - Zip Code:04776-3064
Practice Address - Country:US
Practice Address - Phone:207-365-4335
Practice Address - Fax:207-365-4336
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD11485208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME027976OtherANTHEM STAR #
ME080173483OtherRAILROAD MEDICARE NUMBER
ME10902818OtherCAQH
ME1790871648Medicaid
ME027976OtherANTHEM STAR #
ME080173483OtherRAILROAD MEDICARE NUMBER