Healthcare Provider Details

I. General information

NPI: 1396275707
Provider Name (Legal Business Name): OLIVIA ANNE MARTIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2017
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

462 GRIDER ST
BUFFALO NY
14215-3098
US

IV. Provider business mailing address

UB DEPARTMENT OF SURGERY, DK MILLER BUILDING, 3RD FLOOR 462 GRIDER STREET
BUFFALO NY
14215
US

V. Phone/Fax

Practice location:
  • Phone: 716-898-5283
  • Fax:
Mailing address:
  • Phone: 716-898-5283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number336543
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: