Provider Demographics
NPI:1770754046
Name:THOMAS J. MARTIN, M.D.
Entity type:Organization
Organization Name:THOMAS J. MARTIN, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-887-7725
Mailing Address - Street 1:1350 E COUNTY LINE RD
Mailing Address - Street 2:SUITE I
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-0873
Mailing Address - Country:US
Mailing Address - Phone:317-887-7725
Mailing Address - Fax:317-887-7751
Practice Address - Street 1:1350 E COUNTY LINE RD
Practice Address - Street 2:SUITE I
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-0873
Practice Address - Country:US
Practice Address - Phone:317-887-7725
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100186620BMedicaid
IN100186620BMedicaid
IN610480Medicare PIN