MEDICARE: ADAM A MARTIN MD

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	207N00000X	Dermatology Physician	0101255973	VA

General Provider Information

NPI Number	:	1811211592
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADAM A MARTIN MD

Provider Business Mailing Address
First Line	:	301 CONCOURSE BLVD
Second Line	:	SUITE 190
City	:	GLEN ALLEN
State	:	VA
Zip	:	23059-5643
Country	:	US
Telephone Number	:	804-549-4040
Fax Number	:	804-549-4032

Provider Business Practice Location Address
First Line	:	6946 FOREST AVE STE 200
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23230-1701
Country	:	US
Telephone Number	:	804-549-4040
Fax Number	:	804-549-4032

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

Provider Enumeration Date	:	03/24/2010
Last Update Date	:	05/31/2019

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