Provider Demographics
NPI:1891785374
Name:MARTIN, ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
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 1:434 4TH ST STE 305
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37821-3735
Mailing Address - Country:US
Mailing Address - Phone:865-647-5800
Mailing Address - Fax:865-647-5979
Practice Address - Street 1:434 4TH ST STE 305
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:TN
Practice Address - Zip Code:37821-3735
Practice Address - Country:US
Practice Address - Phone:865-647-5800
Practice Address - Fax:865-647-5979
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2019-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN15406207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ020197Medicaid
KY0644801Medicare PIN
110038587Medicare PIN
TN103I060795Medicare PIN
TN3010271Medicare PIN
P00841526Medicare PIN
TN103I066502Medicare PIN
KYP400017545Medicare PIN
TNA97455Medicare UPIN
KYK027480Medicare PIN