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NPI Code Detail

MEDICARE: LESLIE A MARTIN M.D.

MEDICARE: LESLIE A MARTIN M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RH0000XHematology (Internal Medicine) Physician42799MA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1124012299
Entity Type Code : Individual
Provider Name (Legal Business Name) : LESLIE A MARTIN M.D.
Provider Business Mailing Address
First Line : 77 WARREN ST.
Second Line : RM 339
City : BRIGHTON
State : MA
Zip : 02135
Country : US
Telephone Number : 617-562-5359
Fax Number : 617-562-5415
Provider Business Practice Location Address
First Line : 736 CAMBRIDGE ST
Second Line : MOTHER MARY ROSE FL 3
City : BRIGHTON
State : MA
Zip : 02135-2907
Country : US
Telephone Number : 617-780-3048
Fax Number : 617-789-2959
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/06/2005
Last Update Date : 02/17/2009

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