Provider Demographics
NPI:1952462764
Name:MARTIN, JAMES WALLACE (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:WALLACE
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9010 CHARLES AUGUSTINE DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22308-2822
Mailing Address - Country:US
Mailing Address - Phone:301-619-4884
Mailing Address - Fax:301-619-2196
Practice Address - Street 1:1425 PORTER ST
Practice Address - Street 2:USAMRIID, MED DIV
Practice Address - City:FORT DETRICK
Practice Address - State:MD
Practice Address - Zip Code:21702-9211
Practice Address - Country:US
Practice Address - Phone:301-619-4884
Practice Address - Fax:301-619-2196
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS08021207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease