Provider Demographics
NPI:1356520647
Name:MARTIN, THOMAS CHARLES (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:CHARLES
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 1:40 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-4524
Mailing Address - Country:US
Mailing Address - Phone:207-742-8381
Mailing Address - Fax:
Practice Address - Street 1:40 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-4524
Practice Address - Country:US
Practice Address - Phone:207-742-8381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-02
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME0176072080P0202X
MEMD17607261QM2800X, 2083A0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine
No2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
No261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone