Healthcare Provider Details

I. General information

NPI: 1912953092
Provider Name (Legal Business Name): JAMES MITCHELL MARTIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 07/29/2020
Certification Date: 07/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5221 US ROUTE 60 EAST
HUNTINGTON WV
25705
US

IV. Provider business mailing address

5221 US ROUTE 60 EAST
HUNTINGTON WV
25705-2022
US

V. Phone/Fax

Practice location:
  • Phone: 304-522-1550
  • Fax: 304-522-1073
Mailing address:
  • Phone: 304-522-1550
  • Fax: 304-522-1073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number33197
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number25247
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: