Healthcare Provider Details

I. General information

NPI: 1306821202
Provider Name (Legal Business Name): PATRICK DAVID MARTIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 01/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 MEDICAL CENTER DR
WILMINGTON NC
28401
US

IV. Provider business mailing address

1201 MEDICAL CENTER DR.
WILMINGTON NC
28401
US

V. Phone/Fax

Practice location:
  • Phone: 910-251-8414
  • Fax: 910-251-8736
Mailing address:
  • Phone: 910-251-8414
  • Fax: 910-251-8736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number39022
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number39022
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: