1972585206 NPI number — DR. DAVID ZACHARY MARTIN M.D.

Table of content: DR. DAVID ZACHARY MARTIN M.D. (NPI 1972585206)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972585206 NPI number — DR. DAVID ZACHARY MARTIN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTIN
Provider First Name:
DAVID
Provider Middle Name:
ZACHARY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1972585206
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/03/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5601 LOCH RAVEN BLVD BLDG SUITE101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21239-2945
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-444-1392
Provider Business Mailing Address Fax Number:
443-444-3988

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5601 LOCH RAVEN BLVD BLDG SUITE101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21239-2945
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-444-1392
Provider Business Practice Location Address Fax Number:
443-444-3988
Provider Enumeration Date:
11/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208200000X , with the licence number:  D0058474 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7283425 . This is a "AETNA ALL PLANS EXCEPT HMO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 405073800 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1972585206 . This is a "BRAVO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: P01084428 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 107110 . This is a "JOHN HOPKINS EHP PPMCO USFHP" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 01642018 . This is a "AMERIGROUP" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 1188979 . This is a "CIGNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: AB870001 . This is a "CAREFIRST BLUECROSS BLUESHIELD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 1972585206 . This is a "MARYLAND PHYSICIANS CARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 1972585206 . This is a "UNITED HEALTHCARE - ALL PRODUCTS EXCEPT AMERICHOICE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 8508989 . This is a "AETNA HMO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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