Provider Demographics
NPI:1023092491
Name:MARTIN, JEFFREY ALLEN (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ALLEN
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 1:129 VALLEY VIEW RD
Mailing Address - Street 2:
Mailing Address - City:GREENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18426-4430
Mailing Address - Country:US
Mailing Address - Phone:570-676-8285
Mailing Address - Fax:
Practice Address - Street 1:129 VALLEY VIEW RD
Practice Address - Street 2:
Practice Address - City:GREENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18426-4430
Practice Address - Country:US
Practice Address - Phone:570-676-8285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD050275L207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAG63421Medicare UPIN