Healthcare Provider Details

I. General information

NPI: 1356873129
Provider Name (Legal Business Name): CLAYTON L. MARTIN JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2017
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 SPRUCE ST BSMT WEST
PHILADELPHIA PA
19106-4022
US

IV. Provider business mailing address

3400 SPRUCE ST FL RAVDIN
PHILADELPHIA PA
19104-4238
US

V. Phone/Fax

Practice location:
  • Phone: 215-829-3358
  • Fax: 215-829-3438
Mailing address:
  • Phone: 661-703-1640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD478073
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: