Healthcare Provider Details

I. General information

NPI: 1396494258
Provider Name (Legal Business Name): KEVIN THOMAS MARTIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2022
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 PARNASSUS AVE FL 4
SAN FRANCISCO CA
94143-2206
US

IV. Provider business mailing address

22 S GREENE ST RM N3E09
BALTIMORE MD
21201-1544
US

V. Phone/Fax

Practice location:
  • Phone: 415-514-7952
  • Fax:
Mailing address:
  • Phone: 410-328-6110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA189113
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: