Healthcare Provider Details

I. General information

NPI: 1083638324
Provider Name (Legal Business Name): KATHLEEN L MARTIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 03/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 SABATTUS STREET
LEWISTON ME
04240
US

IV. Provider business mailing address

PO BOX 7291
LEWISTON ME
04243-7291
US

V. Phone/Fax

Practice location:
  • Phone: 207-777-4300
  • Fax: 207-755-3021
Mailing address:
  • Phone: 207-777-8950
  • Fax: 207-777-8800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD15669
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: