Provider Demographics
NPI:1134450836
Name:MARTIN, MARTINA M (MD)
Entity type:Individual
Prefix:
First Name:MARTINA
Middle Name:M
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 LAKESIDE LN
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-2074
Mailing Address - Country:US
Mailing Address - Phone:610-359-9839
Mailing Address - Fax:610-359-9839
Practice Address - Street 1:160 LAKESIDE LN
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-2074
Practice Address - Country:US
Practice Address - Phone:610-359-9839
Practice Address - Fax:610-359-9839
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-19
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD010999E207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology