Healthcare Provider Details

I. General information

NPI: 1144924093
Provider Name (Legal Business Name): ROBERT MARTIN JR. D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 MULLICA HILL RD
MULLICA HILL NJ
08062-4413
US

IV. Provider business mailing address

3401 N BROAD ST
PHILADELPHIA PA
19140-5189
US

V. Phone/Fax

Practice location:
  • Phone: 856-508-8000
  • Fax:
Mailing address:
  • Phone: 800-836-7536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberOT024112
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: