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NPI Code Detail

MEDICARE: STACEY W MARTIN MD

MEDICARE: STACEY W 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
1207Q00000XFamily Medicine Physician9901251NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1417945270
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACEY W MARTIN MD
Provider Business Mailing Address
First Line : PO BOX 71061
Second Line :
City : CHARLOTTE
State : NC
Zip : 28272-1061
Country : US
Telephone Number : 704-455-6521
Fax Number : 704-455-3078
Provider Business Practice Location Address
First Line : 4315 PHYSICIANS BLVD
Second Line : SUITE 101
City : HARRISBURG
State : NC
Zip : 28075-7431
Country : US
Telephone Number : 704-455-6521
Fax Number : 704-455-3078
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/06/2005
Last Update Date : 06/24/2013

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Directions to “ STACEY W MARTIN MD” Practice Location

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