Provider Demographics
NPI:1881235505
Name:O'DONNELL, MARTIN JOHN
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:JOHN
Last Name:O'DONNELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 VALLEY STREET NW
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24210-2859
Mailing Address - Country:US
Mailing Address - Phone:276-628-9547
Mailing Address - Fax:276-628-8221
Practice Address - Street 1:176 VALLEY ST NW
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-2859
Practice Address - Country:US
Practice Address - Phone:276-628-9547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-03
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002905231H00000X
VA2101002511237600000X
VA2201001761231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter