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General NPI Number Information
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NPI Number | 1073031134
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Entity Type | Individual
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Provider Name | MARY MARLENE MARTIN MD
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Gender | Female
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Dates
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Enumeration Date | 09/08/2017
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Last Update Date | 03/27/2024
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Provider Practice Location Address
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Address Line | 3811 OHARA ST
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City | PITTSBURGH
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State | PA
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Zip | 15213-2561
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Country | US
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Telephone | 412-624-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 1149 FREESIA CT
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City | ANN ARBOR
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State | MI
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Zip | 48105-1972
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Country | US
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Telephone | 740-961-2500
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Fax |
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | S.2308793
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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