Provider Demographics
NPI:1922552892
Name:MARTIN PEDIATRIC CLINIC PLLC
Entity Type:Organization
Organization Name:MARTIN PEDIATRIC CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:DOVER
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:252-792-4410
Mailing Address - Street 1:PO BOX 845
Mailing Address - Street 2:312 SOUTH MCCASKEY RD
Mailing Address - City:WILLIAMSTON
Mailing Address - State:NC
Mailing Address - Zip Code:27892-0845
Mailing Address - Country:US
Mailing Address - Phone:252-792-4410
Mailing Address - Fax:252-792-7287
Practice Address - Street 1:312 S MCCASKEY RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSTON
Practice Address - State:NC
Practice Address - Zip Code:27892-2150
Practice Address - Country:US
Practice Address - Phone:252-792-4410
Practice Address - Fax:252-792-7287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-09
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty