Provider Demographics
NPI:1982885125
Name:DAVID R MARTIN MD, INC
Entity Type:Organization
Organization Name:DAVID R MARTIN MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-644-3283
Mailing Address - Street 1:950 S ARROYO PKWY
Mailing Address - Street 2:3RD FLOOR SUITE
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3930
Mailing Address - Country:US
Mailing Address - Phone:626-765-6405
Mailing Address - Fax:626-765-6407
Practice Address - Street 1:950 S ARROYO PKWY
Practice Address - Street 2:3RD FLOOR SUITE
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3930
Practice Address - Country:US
Practice Address - Phone:626-765-6405
Practice Address - Fax:626-765-6407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA62108208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19268Medicare PIN