Provider Demographics
NPI:1801897095
Name:MARTIN, PETER SHAWN (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:SHAWN
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 1:320 E NORTH AVE
Mailing Address - Street 2:AGH EMERGENCY ASSOCS
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-4756
Mailing Address - Country:US
Mailing Address - Phone:412-359-4138
Mailing Address - Fax:412-359-8874
Practice Address - Street 1:320 E NORTH AVE
Practice Address - Street 2:AGH EMERGENCY ASSOCS
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4756
Practice Address - Country:US
Practice Address - Phone:412-359-4138
Practice Address - Fax:412-359-8874
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD069036L207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3004183000Medicaid
OH2223427Medicaid
PA0017590830001Medicaid
PA029162NJRMedicare PIN
PA930083894Medicare PIN
PACG2176Medicare PIN
WV3004183000Medicaid