Provider Demographics
NPI:1659362408
Name:MARTIN, BENJAMIN FREDRIC (MD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:FREDRIC
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 1:1175 WALNUT BOTTOM RD
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17015-9160
Mailing Address - Country:US
Mailing Address - Phone:717-258-9355
Mailing Address - Fax:717-462-4817
Practice Address - Street 1:1175 WALNUT BOTTOM RD
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17015-9160
Practice Address - Country:US
Practice Address - Phone:717-258-9355
Practice Address - Fax:717-462-4817
Is Sole Proprietor?:No
Enumeration Date:2005-11-01
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD069083L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMD069083LOtherMEDICAL LIC NUMBER
PAMD069083LOtherMEDICAL LIC NUMBER
PAMD069083LOtherMEDICAL LIC NUMBER
OHH036270Medicare PIN