Healthcare Provider Details

I. General information

NPI: 1225010143
Provider Name (Legal Business Name): PIERRE THOMAS MARTIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 03/29/2023
Certification Date: 03/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5818 HARBOUR VIEW BLVD SUITE 230
SUFFOLK VA
23435-3315
US

IV. Provider business mailing address

860 OMNI BLVD STE 128
NEWPORT NEWS VA
23606-4430
US

V. Phone/Fax

Practice location:
  • Phone: 757-673-6118
  • Fax: 757-967-9003
Mailing address:
  • Phone: 757-232-8769
  • Fax: 757-232-8875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number0101240884
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: