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NPI Code Detail

MEDICARE: DR. DANIEL ALLEN MARTIN M.D.

MEDICARE: DR. DANIEL ALLEN 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
1208D00000XGeneral Practice Physician01058104AIN
22085R0202XDiagnostic Radiology Physician22899WV

General Provider Information

NPI Number : 1396721817
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DANIEL ALLEN MARTIN M.D.
Provider Business Mailing Address
First Line : PO BOX 780
Second Line :
City : MORGANTOWN
State : WV
Zip : 26507-0780
Country : US
Telephone Number : 304-293-7401
Fax Number :
Provider Business Practice Location Address
First Line : 101 STADIUM DR
Second Line :
City : MORGANTOWN
State : WV
Zip : 26506-7911
Country : US
Telephone Number : 304-598-4000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/16/2005
Last Update Date : 04/15/2022

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