Healthcare Provider Details

I. General information

NPI: 1609891142
Provider Name (Legal Business Name): ROSCOE LYNDON MARTER MD.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 10/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25775 MCBEAN PKWY
VALENCIA CA
91355-3708
US

IV. Provider business mailing address

PO BOX 9602
MISSION HILLS CA
91346-9602
US

V. Phone/Fax

Practice location:
  • Phone: 661-424-8848
  • Fax: 661-424-8849
Mailing address:
  • Phone: 818-837-5637
  • Fax: 818-837-5589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberG76143
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: