1770754046 NPI number — THOMAS J. MARTIN, M.D.

Table of content: (NPI 1770754046)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770754046 NPI number — THOMAS J. MARTIN, M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THOMAS J. MARTIN, M.D.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770754046
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/03/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1350 E COUNTY LINE RD
Provider Second Line Business Mailing Address:
SUITE I
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46227-0873
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-887-7725
Provider Business Mailing Address Fax Number:
317-887-7751

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1350 E COUNTY LINE RD
Provider Second Line Business Practice Location Address:
SUITE I
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46227-0873
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-887-7725
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/14/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MARTIN
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
MD/OWNER
Authorized Official Telephone Number:
317-887-7725

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100186620B , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".