Healthcare Provider Details

I. General information

NPI: 1275510489
Provider Name (Legal Business Name): ROBERT CRAIG MARTIN D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 04/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2410 S QUEEN ST
YORK PA
17402-4941
US

IV. Provider business mailing address

PO BOX 12834
BELFAST ME
04915-4019
US

V. Phone/Fax

Practice location:
  • Phone: 717-718-5511
  • Fax: 717-718-0660
Mailing address:
  • Phone: 717-718-5511
  • Fax: 717-718-0660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberSC001735L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberSC001735L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: