MEDICARE: DR. KENNETH J MARTIN DPM

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	213E00000X	Podiatrist	SC002881L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0060738000	OTHER	PA	IBC
2	11940	OTHER	PA	HEALTH PARTNERS PA
3	31875	OTHER	PA	KEYSTONE MERCY HEALTH PLA
4	0104650501	OTHER	PA	AMERICHOICE OF PA
5	1480	OTHER	PA	BRAVO ELDERHEALTH
6	175404	OTHER	PA	BC BS OF PA
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285626804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH J MARTIN DPM

Provider Business Mailing Address
First Line	:	408 HELEN CIR
Second Line	:
City	:	PENN VALLEY
State	:	PA
Zip	:	19072-1222
Country	:	US
Telephone Number	:	215-877-2555
Fax Number	:	215-877-0240

Provider Business Practice Location Address
First Line	:	7331 BRENTWOOD RD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19151
Country	:	US
Telephone Number	:	215-877-2555
Fax Number	:	215-877-0240

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

Provider Enumeration Date	:	08/19/2005
Last Update Date	:	01/26/2015

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