Healthcare Provider Details

I. General information

NPI: 1255309282
Provider Name (Legal Business Name): CHRISTOPHER J MARTIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 12/31/2020
Certification Date: 10/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DRIVE
MORGANTOWN WV
26506
US

IV. Provider business mailing address

PO BOX 897
MORGANTOWN WV
26507-0897
US

V. Phone/Fax

Practice location:
  • Phone: 304-598-4800
  • Fax: 304-293-6963
Mailing address:
  • Phone: 304-293-7401
  • Fax: 304-293-6963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number19856
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: