Provider Demographics
NPI:1023179504
Name:MARTIN, C GREGORY (MD)
Entity type:Individual
Prefix:
First Name:C
Middle Name:GREGORY
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CHARLES
Other - Middle Name:GREGORY
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4947 GREEN DOLPHIN WAY
Mailing Address - Street 2:
Mailing Address - City:KIAWAH ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29455-5420
Mailing Address - Country:US
Mailing Address - Phone:978-618-4422
Mailing Address - Fax:
Practice Address - Street 1:3226 MAYBANK HWY
Practice Address - Street 2:
Practice Address - City:JOHNS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29455-4858
Practice Address - Country:US
Practice Address - Phone:843-266-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA45652207R00000X
SCMD51916207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA707153OtherTUFTS HEALTH PLAN
MAB26238OtherBCBSMA
MAAA42082OtherHPHC
MAB26238OtherBCBSMA
MAB26238Medicare ID - Type Unspecified