MEDICARE: JARROD MARTIN

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1609482744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JARROD MARTIN

Provider Business Mailing Address
First Line	:	6 MILNE WAY
Second Line	:
City	:	GLOUCESTER
State	:	MA
Zip	:	01930-1706
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6 MILNE WAY
Second Line	:
City	:	GLOUCESTER
State	:	MA
Zip	:	01930-1706
Country	:	US
Telephone Number	:	978-652-8230
Fax Number	:

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

Provider Enumeration Date	:	09/22/2020
Last Update Date	:	09/22/2020

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Directions to “ JARROD MARTIN ” Practice Location

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