MEDICARE: DR. TRENT D MARTIN M.D.

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
1	207RG0100X	Gastroenterology Physician	0101043272	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194703728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TRENT D MARTIN M.D.

Provider Business Mailing Address
First Line	:	1020 INDEPENDENCE BLVD
Second Line	:	SUITE 110
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-5500
Country	:	US
Telephone Number	:	757-464-1644
Fax Number	:	757-363-1071

Provider Business Practice Location Address
First Line	:	1925 GLENN MITCHELL DR
Second Line	:	STE 102
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23456-0170
Country	:	US
Telephone Number	:	757-464-1644
Fax Number	:	757-363-1071

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2006
Last Update Date	:	03/01/2016

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Directions to “ DR. TRENT D MARTIN M.D.” Practice Location

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