Provider Demographics
NPI:1255395620
Name:CORREA, MARTIN R (MD)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:R
Last Name:CORREA
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 1:10301 GEORGIA AVE STE 306
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-5020
Mailing Address - Country:US
Mailing Address - Phone:013-681-9670
Mailing Address - Fax:301-681-6055
Practice Address - Street 1:10301 GEORGIA AVE STE 306
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-5020
Practice Address - Country:US
Practice Address - Phone:013-681-9670
Practice Address - Fax:301-681-6055
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86090207K00000X
MDD0088565207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL265729500Medicaid
FL265729500Medicaid
FLE8693YMedicare ID - Type Unspecified