Healthcare Provider Details

I. General information

NPI: 1619944600
Provider Name (Legal Business Name): WALTER E. MARTIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 KILLINGWORTH RD
HIGGANUM CT
06441-4392
US

IV. Provider business mailing address

415 KILLINGWORTH RD
HIGGANUM CT
06441-4392
US

V. Phone/Fax

Practice location:
  • Phone: 860-345-8535
  • Fax: 860-345-8678
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number9605
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD21468
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD039667L
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME47497
License Number StateFL
# 5
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number82557
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: