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General NPI Number Information
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NPI Number | 1861540627
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Entity Type | Individual
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Provider Name | DAVID CHARLES MARTIN M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 9900 BREN RD E MN008-W130
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City | MINNETONKA
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State | MN
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Zip | 55343-9664
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Country | US
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Telephone | 952-936-6509
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Fax |
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Provider Business Mailing Address
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Address Line | 5955 OXFORD ST N
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City | SHOREVIEW
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State | MN
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Zip | 55126-8415
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Country | US
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Telephone | 612-968-6751
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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 | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | MD025072E
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License Number State | PA
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