Healthcare Provider Details

I. General information

NPI: 1144230087
Provider Name (Legal Business Name): HAROLD L MARTIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 01/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 ENDO LN SUITE 1
HAMLET NC
28345-4566
US

IV. Provider business mailing address

108 ENDO LN SUITE 1
HAMLET NC
28345-4566
US

V. Phone/Fax

Practice location:
  • Phone: 910-205-8909
  • Fax: 910-205-8952
Mailing address:
  • Phone: 910-205-8909
  • Fax: 910-205-8952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME0033154
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2006-01482
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number047924
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number13989
License Number StateAL
# 5
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number10901
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: