Provider Demographics
NPI:1831152099
Name:DECKER, MARTIN JOSEPH (DO)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:JOSEPH
Last Name:DECKER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 WATER ST
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-3434
Mailing Address - Country:US
Mailing Address - Phone:814-337-1144
Mailing Address - Fax:814-337-0941
Practice Address - Street 1:901 WATER ST
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-3434
Practice Address - Country:US
Practice Address - Phone:814-337-1144
Practice Address - Fax:814-337-0941
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS010482L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine