Healthcare Provider Details

I. General information

NPI: 1033552856
Provider Name (Legal Business Name): TODD MARTIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2013
Last Update Date: 10/09/2020
Certification Date: 10/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 COUNTY HOUSE RD
SEWELL NJ
08080-2525
US

IV. Provider business mailing address

833 CHESTNUT ST SUITE 210
PHILADELPHIA PA
19107-4414
US

V. Phone/Fax

Practice location:
  • Phone: 215-823-5800
  • Fax: 877-823-5230
Mailing address:
  • Phone: 215-955-9823
  • Fax: 215-503-6116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD455454
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: