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General NPI Number Information
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NPI Number | 1013073477
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Entity Type | Individual
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Provider Name | NIELS DOUGLAS MARTIN MD
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Gender | Male
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Dates
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Enumeration Date | 12/29/2006
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Last Update Date | 12/24/2025
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Provider Practice Location Address
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Address Line | 51 N 39TH ST
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City | PHILADELPHIA
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State | PA
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Zip | 19104-2640
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Country | US
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Telephone | 215-349-8310
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Fax | 215-724-3560
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Provider Business Mailing Address
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Address Line | 51 N 39TH ST MEDICAL OFFICE BUILDING, 1ST FLOOR, SUITE 120
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City | PHILADELPHIA
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State | PA
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Zip | 19104-2640
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Country | US
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Telephone | 215-349-8310
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Fax | 215-724-3560
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | MD420992
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 2086S0102X
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Taxonomy Name | Surgical Critical Care Physician
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License Number | MD420992
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 2086S0127X
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Taxonomy Name | Trauma Surgery Physician
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License Number | MD420992
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License Number State | PA
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