Provider Demographics
NPI:1811225329
Name:MARTIN E HALE MD PA
Entity Type:Organization
Organization Name:MARTIN E HALE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:E
Authorized Official - Last Name:HALE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-474-3223
Mailing Address - Street 1:499 NW 70TH AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-7500
Mailing Address - Country:US
Mailing Address - Phone:954-474-3223
Mailing Address - Fax:954-474-3226
Practice Address - Street 1:499 NW 70TH AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-7500
Practice Address - Country:US
Practice Address - Phone:954-474-3223
Practice Address - Fax:954-474-3226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-20
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0046937174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CM133AMedicare PIN
FLD63287Medicare UPIN