Provider Demographics
NPI:1881705572
Name:MARTIN, VICTOR (MD)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:
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 1:16 DALES DRIVE
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:CT
Mailing Address - Zip Code:06525
Mailing Address - Country:US
Mailing Address - Phone:203-675-6195
Mailing Address - Fax:203-776-0091
Practice Address - Street 1:136 SHERMAN AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511
Practice Address - Country:US
Practice Address - Phone:203-675-6195
Practice Address - Fax:203-776-0091
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT039467207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H34620Medicare UPIN
660000028Medicare ID - Type Unspecified