Provider Demographics
NPI:1295778595
Name:MARTIN, MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2235 CEDAR LN
Mailing Address - Street 2:SUITE 302
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-5202
Mailing Address - Country:US
Mailing Address - Phone:917-716-1854
Mailing Address - Fax:703-344-7309
Practice Address - Street 1:2235 CEDAR LN
Practice Address - Street 2:SUITE 302
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-5202
Practice Address - Country:US
Practice Address - Phone:917-716-1854
Practice Address - Fax:703-344-7309
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101237894208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics