Provider Demographics
NPI:1811982960
Name:MARTIN, THOMAS PATRICK JR (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:PATRICK
Last Name:MARTIN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:THOMAS
Other - Middle Name:PATRICK
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1528 RED TIDE RD
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-9406
Mailing Address - Country:US
Mailing Address - Phone:412-427-5688
Mailing Address - Fax:
Practice Address - Street 1:1528 RED TIDE RD
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466-9406
Practice Address - Country:US
Practice Address - Phone:412-427-5688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-14
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD044453E207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3004639000Medicaid
OH2768401Medicaid
PA0012340960006Medicaid
PA056558NJRMedicare PIN
PA0012340960006Medicaid
OH2768401Medicaid
WV3004639000Medicaid
PA930114855Medicare PIN