MEDICARE: MELISSA MARTIN DO

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	2085R0202X	Diagnostic Radiology Physician	2591	AZ

General Provider Information

NPI Number	:	1326056409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA MARTIN DO

Provider Business Mailing Address
First Line	:	4419 E VERMONT AVE N
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-1740
Country	:	US
Telephone Number	:	602-952-1716
Fax Number	:	602-952-1916

Provider Business Practice Location Address
First Line	:	4419 E VERMONT AVE N
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-1740
Country	:	US
Telephone Number	:	602-952-1716
Fax Number	:	602-952-1916

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

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	07/08/2007

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Directions to “ MELISSA MARTIN DO” Practice Location

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