Healthcare Provider Details

I. General information

NPI: 1982607792
Provider Name (Legal Business Name): NEIL F MARTIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 03/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5454 WISCONSIN AVE STE 950
CHEVY CHASE MD
20815-6912
US

IV. Provider business mailing address

5454 WISCONSIN AVE STE 950
CHEVY CHASE MD
20815-6912
US

V. Phone/Fax

Practice location:
  • Phone: 301-657-5700
  • Fax: 301-654-9132
Mailing address:
  • Phone: 301-657-5700
  • Fax: 301-654-9132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD12779
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberD0026299
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: