Provider Demographics
NPI:1821408568
Name:MARTIN, COREY (MD)
Entity Type:Individual
Prefix:DR
First Name:COREY
Middle Name:
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 1:2411 W BELVEDERE AVE STE 504
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-5232
Mailing Address - Country:US
Mailing Address - Phone:410-601-8331
Mailing Address - Fax:410-601-5389
Practice Address - Street 1:2411 W BELVEDERE AVE STE 504
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-5232
Practice Address - Country:US
Practice Address - Phone:410-601-8331
Practice Address - Fax:410-601-5389
Is Sole Proprietor?:No
Enumeration Date:2014-05-03
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MDD903612080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program