Healthcare Provider Details

I. General information

NPI: 1942296470
Provider Name (Legal Business Name): WILLIAM JOSEPH MARTIN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 02/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8TH & RACE ST TEMPLE UNIVERSITY FOOT & ANKLE INSTITUTE
PHILADELPHIA PA
19107-2496
US

IV. Provider business mailing address

PO BOX 827282 TEMPLE UNIVERSITY FOOT & ANKLE INSTITUTE
PHILADELPHIA PA
19182-7282
US

V. Phone/Fax

Practice location:
  • Phone: 215-238-6600
  • Fax: 215-629-4905
Mailing address:
  • Phone: 215-238-6600
  • Fax: 215-629-0716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberSC001619L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberSC001619L
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberSC001619L
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberSC001619L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: