Provider Demographics
NPI:1932433877
Name:GINA MARTIN, M.D., P.L.L.C.
Entity Type:Organization
Organization Name:GINA MARTIN, M.D., P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-394-3625
Mailing Address - Street 1:2123 RIVER CHASE DR
Mailing Address - Street 2:
Mailing Address - City:EDEN
Mailing Address - State:NC
Mailing Address - Zip Code:27288-9463
Mailing Address - Country:US
Mailing Address - Phone:336-394-3625
Mailing Address - Fax:336-623-7399
Practice Address - Street 1:618 S PIERCE ST
Practice Address - Street 2:
Practice Address - City:EDEN
Practice Address - State:NC
Practice Address - Zip Code:27288-5863
Practice Address - Country:US
Practice Address - Phone:336-394-3625
Practice Address - Fax:336-623-7399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-24
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCH38097Medicare UPIN