Healthcare Provider Details

I. General information

NPI: 1134147994
Provider Name (Legal Business Name): GEORGE M MARTIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 06/12/2023
Certification Date: 06/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 WAILEA IKE PL STE A104
KIHEI HI
96753-6502
US

IV. Provider business mailing address

41 E LIPOA STREET SUITE 21
KIHEI HI
96753-8148
US

V. Phone/Fax

Practice location:
  • Phone: 808-875-0511
  • Fax: 808-875-8595
Mailing address:
  • Phone: 808-875-0511
  • Fax: 808-875-8595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD6819
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberMD6819
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: