Provider Demographics
NPI:1861509481
Name:JANIS, MARTIN (MD)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:
Last Name:JANIS
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 10750
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27605-0750
Mailing Address - Country:US
Mailing Address - Phone:919-782-7576
Mailing Address - Fax:919-782-7573
Practice Address - Street 1:3921 SUNSET RIDGE RD STE 101
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6677
Practice Address - Country:US
Practice Address - Phone:919-782-7576
Practice Address - Fax:919-782-7573
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9900551207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8912794Medicaid
NC8912794Medicaid
NC2274517BMedicare PIN