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1952364341

NPI Code Detail

MEDICARE: MICHAEL MARTIN MD

MEDICARE: MICHAEL 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
1	207R00000X	Internal Medicine Physician	018063	CT

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00087818	OTHER	CT	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	010018083CT02	OTHER	CT	ANTHEM
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	018083	OTHER	CT	CTCARE

General Provider Information

NPI Number	:	1952364341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL MARTIN MD

Provider Business Mailing Address
First Line	:	PO BOX 3136
Second Line	:
City	:	VERNON
State	:	CT
Zip	:	06066-2036
Country	:	US
Telephone Number	:	860-896-1422
Fax Number	:	860-896-1425

Provider Business Practice Location Address
First Line	:	1504 SULLIVAN AVE
Second Line	:
City	:	SOUTH WINDSOR
State	:	CT
Zip	:	06074-2711
Country	:	US
Telephone Number	:	860-644-1523
Fax Number	:	860-648-9468

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

Provider Enumeration Date	:	04/08/2006
Last Update Date	:	06/07/2010

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Directions to “ MICHAEL MARTIN MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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