Healthcare Provider Details

I. General information

NPI: 1376559906
Provider Name (Legal Business Name): THOMAS J MARTIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 01/17/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 E MAIN ST
WORTHINGTON IN
47471-1603
US

IV. Provider business mailing address

1185 N 1000 W
LINTON IN
47441-5282
US

V. Phone/Fax

Practice location:
  • Phone: 812-847-4481
  • Fax: 844-658-7526
Mailing address:
  • Phone: 812-847-5212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01037295
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: