Provider Demographics
NPI:1861466310
Name:MARTIN, DAVID EUGENE (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:EUGENE
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 1:1 GUTHRIE SQ
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-1625
Mailing Address - Country:US
Mailing Address - Phone:570-888-5858
Mailing Address - Fax:
Practice Address - Street 1:176 DENISON PKWY E
Practice Address - Street 2:RADIOLOGY DEPARTMENT
Practice Address - City:CORNING
Practice Address - State:NY
Practice Address - Zip Code:14830-2814
Practice Address - Country:US
Practice Address - Phone:607-937-7200
Practice Address - Fax:607-937-7860
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1075362085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00632884Medicaid
PA1015357440001Medicaid
NYRA9954Medicare PIN
G04188Medicare UPIN
NYP00319055Medicare PIN