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NPI Code Detail

MEDICARE: LEE BALDWIN MARTIN JR. MD

MEDICARE:   LEE BALDWIN MARTIN JR. MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician0101020870VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1B6630001OTHERCAREFIRST BCBS

General Provider Information

NPI Number : 1134113467
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEE BALDWIN MARTIN JR. MD
Provider Business Mailing Address
First Line : 437 N PARK DR
Second Line : STE 1
City : ARLINGTON
State : VA
Zip : 22203-2315
Country : US
Telephone Number : 703-527-1339
Fax Number : 703-527-9733
Provider Business Practice Location Address
First Line : 437 N PARK DR
Second Line : STE 1
City : ARLINGTON
State : VA
Zip : 22203-2315
Country : US
Telephone Number : 703-527-1339
Fax Number : 703-527-9733
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/01/2005
Last Update Date : 05/23/2016

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