Provider Demographics
NPI:1265112692
Name:MARTIN ORTHOPAEDIC & WELLNESS GROUP
Entity type:Organization
Organization Name:MARTIN ORTHOPAEDIC & WELLNESS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JABARI
Authorized Official - Middle Name:IAN JUSTIN
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:443-333-9667
Mailing Address - Street 1:7525 GREENWAY CENTER DR STE 214
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-3525
Mailing Address - Country:US
Mailing Address - Phone:443-333-9667
Mailing Address - Fax:443-339-4056
Practice Address - Street 1:4255 ALTAMONT PL STE 201
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:MD
Practice Address - Zip Code:20695-3024
Practice Address - Country:US
Practice Address - Phone:443-333-9667
Practice Address - Fax:443-339-4056
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARTIN ORTHOPAEDIC & WELLNESS GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-07-20
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty