MEDICARE: WALTER E. 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	9605	MT
2	207R00000X	Internal Medicine Physician	MD21468	ME
3	207R00000X	Internal Medicine Physician	MD039667L	PA
4	207R00000X	Internal Medicine Physician	ME47497	FL
5	207R00000X	Internal Medicine Physician	82557	CT

General Provider Information

NPI Number	:	1619944600
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WALTER E. MARTIN M.D.

Provider Business Mailing Address
First Line	:	415 KILLINGWORTH RD
Second Line	:
City	:	HIGGANUM
State	:	CT
Zip	:	06441-4392
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	415 KILLINGWORTH RD
Second Line	:
City	:	HIGGANUM
State	:	CT
Zip	:	06441-4392
Country	:	US
Telephone Number	:	860-345-8535
Fax Number	:	860-345-8678

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

Provider Enumeration Date	:	03/08/2006
Last Update Date	:	07/28/2025

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