Provider Demographics
NPI:1922443019
Name:MARTIN, JONATHAN VASILIOS SAGUAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:VASILIOS SAGUAN
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1452 ROBERT BRADBY DR APT B
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48207-4923
Mailing Address - Country:US
Mailing Address - Phone:530-401-4248
Mailing Address - Fax:
Practice Address - Street 1:101 NICOLLS RD
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-2874
Practice Address - Country:US
Practice Address - Phone:631-444-8329
Practice Address - Fax:631-444-6176
Is Sole Proprietor?:No
Enumeration Date:2013-05-03
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3159422086S0102X, 2086S0127X, 208600000X
MN710892086S0102X
MI43011033062086S0102X, 208600000X
AZ654072086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery