Provider Demographics
NPI:1952309510
Name:MARTIN, DAVID L (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:L
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2101 JACKSON ST
Mailing Address - Street 2:STE 201
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46016-4388
Mailing Address - Country:US
Mailing Address - Phone:765-649-0161
Mailing Address - Fax:765-644-4995
Practice Address - Street 1:2101 JACKSON ST
Practice Address - Street 2:STE 201
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46016-4388
Practice Address - Country:US
Practice Address - Phone:765-649-0161
Practice Address - Fax:765-644-4995
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01020486207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E41546Medicare UPIN
503460Medicare ID - Type Unspecified