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NPI Code Detail

MEDICARE: DR. THOMAS CHARLES MARTIN JR. M.D.

MEDICARE: DR. THOMAS CHARLES MARTIN JR. 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
1207ZP0102XAnatomic Pathology & Clinical Pathology Physician200101092NC
2207ZP0102XAnatomic Pathology & Clinical Pathology Physician26481WV

General Provider Information

NPI Number : 1326049586
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. THOMAS CHARLES MARTIN JR. M.D.
Provider Business Mailing Address
First Line : 118 12TH STREET EXT
Second Line :
City : PRINCETON
State : WV
Zip : 24740-2352
Country : US
Telephone Number : 304-431-5168
Fax Number :
Provider Business Practice Location Address
First Line : 122 12TH ST
Second Line :
City : PRINCETON
State : WV
Zip : 24740-2312
Country : US
Telephone Number : 304-487-7349
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/09/2005
Last Update Date : 04/25/2018

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