Healthcare Provider Details

I. General information

NPI: 1710200654
Provider Name (Legal Business Name): ALLISON MARIE MARTIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2010
Last Update Date: 05/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3415 BAINBRIDGE AVE
BRONX NY
10467-2403
US

IV. Provider business mailing address

600 N WOLFE ST JOHNS HOPKINS HOSPITAL / CMSC 800
BALTIMORE MD
21287-0005
US

V. Phone/Fax

Practice location:
  • Phone: 718-741-2342
  • Fax: 718-920-6506
Mailing address:
  • Phone: 410-614-5055
  • Fax: 410-955-0028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number296377
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number296377
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: