Provider Demographics
NPI:1972585206
Name:MARTIN, DAVID ZACHARY (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ZACHARY
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:5601 LOCH RAVEN BLVD BLDG SUITE101
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21239-2945
Mailing Address - Country:US
Mailing Address - Phone:443-444-1392
Mailing Address - Fax:443-444-3988
Practice Address - Street 1:5601 LOCH RAVEN BLVD BLDG SUITE101
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21239-2945
Practice Address - Country:US
Practice Address - Phone:443-444-1392
Practice Address - Fax:443-444-3988
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0058474208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD7283425OtherAETNA ALL PLANS EXCEPT HMO
MD405073800Medicaid
MD1972585206OtherBRAVO
MDP01084428OtherRAILROAD MEDICARE
MD107110OtherJOHN HOPKINS EHP PPMCO USFHP
MD01642018OtherAMERIGROUP
MD1188979OtherCIGNA
MDAB870001OtherCAREFIRST BLUECROSS BLUESHIELD
MD1972585206OtherMARYLAND PHYSICIANS CARE
MD1972585206OtherUNITED HEALTHCARE - ALL PRODUCTS EXCEPT AMERICHOICE
MD8508989OtherAETNA HMO
MDH80517Medicare UPIN