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NPI Code Detail

MEDICARE: TYLER MARTIN

MEDICARE: TYLER MARTIN
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
1363A00000XPhysician Assistant1868SC

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 : 1649524455
Entity Type Code : Individual
Provider Name (Legal Business Name) : TYLER MARTIN
Provider Business Mailing Address
First Line : PO BOX 602645
Second Line :
City : CHARLOTTE
State : NC
Zip : 28260-2645
Country : US
Telephone Number : 843-789-1620
Fax Number : 843-724-2454
Provider Business Practice Location Address
First Line : 2095 HENRY TECKLENBURG DR
Second Line :
City : CHARLESTON
State : SC
Zip : 29414-5733
Country : US
Telephone Number : 843-402-1037
Fax Number : 843-402-1295
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/31/2012
Last Update Date : 03/29/2026

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Directions to “ TYLER MARTIN ” Practice Location

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