MEDICARE: MARTIN JANIS 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
1	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	9900551	NC

Other Identifiers

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

General Provider Information

NPI Number	:	1861509481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTIN JANIS MD

Provider Business Mailing Address
First Line	:	PO BOX 10750
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27605-0750
Country	:	US
Telephone Number	:	919-782-7576
Fax Number	:	919-782-7573

Provider Business Practice Location Address
First Line	:	3921 SUNSET RIDGE RD STE 101
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27607-6677
Country	:	US
Telephone Number	:	919-782-7576
Fax Number	:	919-782-7573

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

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	12/11/2015

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