Provider Demographics
NPI:1265422463
Name:MARTIN, MICHAEL D (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:D
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 1:250B BUTLER CMNS
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-2485
Mailing Address - Country:US
Mailing Address - Phone:724-987-4368
Mailing Address - Fax:724-431-4307
Practice Address - Street 1:21 FRANKLIN VILLAGE MALL
Practice Address - Street 2:
Practice Address - City:KITTANNING
Practice Address - State:PA
Practice Address - Zip Code:16201-8803
Practice Address - Country:US
Practice Address - Phone:724-543-3278
Practice Address - Fax:724-543-3283
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD022713E207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA252317OtherUPMC
PA000410457OtherBLUE SHIELD
PA0009625590005Medicaid
PA0009625590005Medicaid
PA000410457OtherBLUE SHIELD