Provider Demographics
NPI:1942448493
Name:JOHN D. MARTIN, PHD.P.C.
Entity Type:Organization
Organization Name:JOHN D. MARTIN, PHD.P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:781-383-6740
Mailing Address - Street 1:P.O. BOX 100
Mailing Address - Street 2:
Mailing Address - City:NORTH SCITUATE
Mailing Address - State:MA
Mailing Address - Zip Code:02060-1581
Mailing Address - Country:US
Mailing Address - Phone:781-378-0942
Mailing Address - Fax:781-378-0942
Practice Address - Street 1:9 DOCTORS HILL DR
Practice Address - Street 2:
Practice Address - City:SCITUATE
Practice Address - State:MA
Practice Address - Zip Code:02066-3650
Practice Address - Country:US
Practice Address - Phone:781-378-0942
Practice Address - Fax:781-378-0942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-21
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA420103T00000X
MA420103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW01413Medicare UPIN