Healthcare Provider Details

I. General information

NPI: 1467434290
Provider Name (Legal Business Name): DANIEL CHRISOPHER MARTIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 09/12/2020
Certification Date: 09/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7650 E PARHAM RD SUITE 100
RICHMOND VA
23294-4373
US

IV. Provider business mailing address

1115 BOULDERS PKWY SUITE 200
NORTH CHESTERFIELD VA
23225-4067
US

V. Phone/Fax

Practice location:
  • Phone: 804-288-3136
  • Fax: 804-288-4538
Mailing address:
  • Phone: 804-560-5595
  • Fax: 804-560-9029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number0101040954
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number0101040954
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: