Healthcare Provider Details

I. General information

NPI: 1225006984
Provider Name (Legal Business Name): THOMAS J MARTIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 12/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 UNIVERSITY DR
HERSHEY PA
17033-2360
US

IV. Provider business mailing address

PO BOX 858
HERSHEY PA
17033-0858
US

V. Phone/Fax

Practice location:
  • Phone: 800-243-1455
  • Fax:
Mailing address:
  • Phone: 800-243-1455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD027820L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2080S0010X
TaxonomyPediatric Sports Medicine Physician
License NumberMD027820L
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD027820L
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number72285
License Number StateWI

VII. Legacy identifiers

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

# 1
Identifier0006915270007
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 2
IdentifierD68464
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerHEALTHAMERICA
# 3
Identifier5373568
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerAETNA
# 4
Identifier014648
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerHIGHMARK BLUE SHIELD
# 5
Identifier159
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerGEISINGER HEALTH PLAN
# 6
Identifier2517527
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerUNITEDHEALTHCARE
# 7
Identifier002673
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerFIRST PRIORITY HEALTH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: