Healthcare Provider Details

I. General information

NPI: 1689776361
Provider Name (Legal Business Name): WENDY MAYER MARTIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: WENDY ANN MARTIN

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 07/27/2023
Certification Date: 07/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 SOUTH FRUIT STREET
CONCORD NH
03301
US

IV. Provider business mailing address

PO BOX 2824
CONCORD NH
03302
US

V. Phone/Fax

Practice location:
  • Phone: 603-271-5994
  • Fax: 781-744-5235
Mailing address:
  • Phone: 781-744-8013
  • Fax: 781-744-5235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number256591
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number13551
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: