Healthcare Provider Details

I. General information

NPI: 1184308785
Provider Name (Legal Business Name): DEIRBHILE MARTIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2023
Last Update Date: 06/14/2023
Certification Date: 06/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 WALNUT ST
PHILADELPHIA PA
19107-5563
US

IV. Provider business mailing address

221 S 12TH ST APT N304
PHILADELPHIA PA
19107-5553
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-8666
  • Fax:
Mailing address:
  • Phone: 617-455-1842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMT228132
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: