Healthcare Provider Details

I. General information

NPI: 1134122955
Provider Name (Legal Business Name): CHRISTOPHER G MARTIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 09/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 BRYANT WOODS S
AMHERST NY
14228-3604
US

IV. Provider business mailing address

85 BRYANT WOODS S
AMHERST NY
14228-3604
US

V. Phone/Fax

Practice location:
  • Phone: 716-689-3333
  • Fax: 716-689-9866
Mailing address:
  • Phone: 716-689-3333
  • Fax: 716-689-9866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number191971
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier00020243301
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerUNIVERA
# 2
Identifier01659241
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer
# 3
Identifier1508057
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerINDEPENDENT HEALTH
# 4
Identifier10458757
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerCAQH
# 5
Identifier157862
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerVALUE OPTIONS
# 6
Identifier000524147005
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerHEALTH INTEGRATED

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: