Provider Demographics
NPI:1821067638
Name:ONEILL, MARTIN J JR (MD)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:J
Last Name:ONEILL
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:550 LANDMARK AVE
Mailing Address - Street 2:PO BOX 550
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47402-0550
Mailing Address - Country:US
Mailing Address - Phone:812-332-9103
Mailing Address - Fax:812-355-6535
Practice Address - Street 1:550 LANDMARK AVE
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403
Practice Address - Country:US
Practice Address - Phone:812-331-3401
Practice Address - Fax:812-335-0027
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01022292A2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
063280GGMedicare ID - Type Unspecified
B61079Medicare UPIN