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General NPI Number Information
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NPI Number | 1366736019
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Entity Type | Individual
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Provider Name | STEPHEN CRAIG MARTIN MD
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Gender | Male
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Dates
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Enumeration Date | 05/30/2011
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Last Update Date | 05/23/2021
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Provider Practice Location Address
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Address Line | 900 W FARIS RD FL 2
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City | GREENVILLE
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State | SC
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Zip | 29605-4255
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Country | US
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Telephone | 864-455-8898
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Fax |
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Provider Business Mailing Address
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Address Line | 300 E MCBEE AVE FL 4
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City | GREENVILLE
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State | SC
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Zip | 29601-2842
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Country | US
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Telephone | 864-522-8617
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 33589
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 2080P0207X
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Taxonomy Name | Pediatric Hematology & Oncology Physician
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License Number | 33589
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License Number State | SC
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