Provider Demographics
NPI:1295715688
Name:PARKER, MARTIN I (MD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:I
Last Name:PARKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 JAMES ST
Mailing Address - Street 2:EDISON RADIOLOGY GROUP, PA
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-3947
Mailing Address - Country:US
Mailing Address - Phone:732-321-7917
Mailing Address - Fax:732-767-2968
Practice Address - Street 1:65 JAMES ST
Practice Address - Street 2:EDISON RADIOLOGY GROUP, PA
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-3947
Practice Address - Country:US
Practice Address - Phone:732-321-7917
Practice Address - Fax:732-767-2968
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA027669002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0327701Medicaid
NJ526133Medicare ID - Type Unspecified
NJE13307Medicare UPIN