Provider Demographics
NPI:1942260831
Name:MARTIN, H FRED (MD)
Entity Type:Individual
Prefix:
First Name:H FRED
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:PO BOX 579
Mailing Address - Street 2:56 S. HIGH STREET
Mailing Address - City:ARENDTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17303-0579
Mailing Address - Country:US
Mailing Address - Phone:717-677-8626
Mailing Address - Fax:717-677-4783
Practice Address - Street 1:56 S HIGH STREET
Practice Address - Street 2:
Practice Address - City:ARENDTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17303
Practice Address - Country:US
Practice Address - Phone:717-677-8626
Practice Address - Fax:717-677-4783
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD025270-E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA163357Medicare PIN
PAD68724Medicare UPIN