Healthcare Provider Details

I. General information

NPI: 1831210020
Provider Name (Legal Business Name): CHRISTOPHER SCOTT MARTIN ATC, CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 07/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 ROCKVILLE PIKE
BETHESDA MD
20889-0001
US

IV. Provider business mailing address

808 CINDY LN
WESTMINSTER MD
21157-7638
US

V. Phone/Fax

Practice location:
  • Phone: 443-377-8453
  • Fax:
Mailing address:
  • Phone: 443-377-8453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberA0000204
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: