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1528040623

NPI Code Detail

MEDICARE: MICHAEL J MARTIN M.D.

MEDICARE: MICHAEL J 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
1	207R00000X	Internal Medicine Physician	0101252860	VA
2	207R00000X	Internal Medicine Physician	33863	NC

Other Identifiers

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

General Provider Information

NPI Number	:	1528040623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL J MARTIN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 601643
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-1643
Country	:	US
Telephone Number	:	704-667-6750
Fax Number	:	704-667-6751

Provider Business Practice Location Address
First Line	:	6115 PARK SOUTH DR STE 100
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28210-3281
Country	:	US
Telephone Number	:	704-554-8787
Fax Number	:	704-554-8774

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2005
Last Update Date	:	12/13/2017

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Directions to “ MICHAEL J MARTIN M.D.” Practice Location

Language	Start Address	Practice Location

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