MEDICARE: PIERRE THOMAS MARTIN 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
1	207Y00000X	Otolaryngology Physician	0101240884	VA

General Provider Information

NPI Number	:	1225010143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PIERRE THOMAS MARTIN MD

Provider Business Mailing Address
First Line	:	860 OMNI BLVD STE 128
Second Line	:
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23606-4430
Country	:	US
Telephone Number	:	757-232-8769
Fax Number	:	757-232-8875

Provider Business Practice Location Address
First Line	:	5818 HARBOUR VIEW BLVD
Second Line	:	SUITE 230
City	:	SUFFOLK
State	:	VA
Zip	:	23435-3315
Country	:	US
Telephone Number	:	757-673-6118
Fax Number	:	757-967-9003

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

Provider Enumeration Date	:	11/16/2005
Last Update Date	:	03/29/2023

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