Healthcare Provider Details

I. General information

NPI: 1679696843
Provider Name (Legal Business Name): ALLAN BRADLEY MARTIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 07/07/2022
Certification Date: 07/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

348 GRANT ST
SALEM NJ
08079-2108
US

IV. Provider business mailing address

348 GRANT ST
SALEM NJ
08079-2108
US

V. Phone/Fax

Practice location:
  • Phone: 856-506-6439
  • Fax: 609-589-3947
Mailing address:
  • Phone: 856-506-6439
  • Fax: 609-589-3947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number25MA03465400
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number25MA03465400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: