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NPI Code Detail

MEDICARE: MARTIN A. EIDLIN M.D.

MEDICARE: MARTIN A. EIDLIN 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
1207R00000XInternal Medicine Physician0101033447VA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1110187592OTHERVARAIL ROAD MEDICARE NUMBER

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1336104728
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARTIN A. EIDLIN M.D.
Provider Business Mailing Address
First Line : PO BOX 758963
Second Line :
City : BALTIMORE
State : MD
Zip : 21275-8963
Country : US
Telephone Number : 804-822-4355
Fax Number :
Provider Business Practice Location Address
First Line : 3432 HOLLAND RD
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23452-4846
Country : US
Telephone Number : 757-468-1855
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/19/2006
Last Update Date : 10/23/2012

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