Healthcare Provider Details

I. General information

NPI: 1659244366
Provider Name (Legal Business Name): WILLIAM EUGENE MARTIN III LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2025
Last Update Date: 10/24/2025
Certification Date: 09/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 WORCESTER PROVIDENCE TPKE
SUTTON MA
01590-2902
US

IV. Provider business mailing address

511 PARK AVE APT 3
WORCESTER MA
01603-2534
US

V. Phone/Fax

Practice location:
  • Phone: 508-865-5068
  • Fax:
Mailing address:
  • Phone: 207-295-3984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: