Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 035268 | CT |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 035268 | CT |
NPI | 1023045143 |
---|---|
Provider Name | David Jon Martin |
First Address | Hamden, CT 06518-3209 |
Second Address | Trumbull, CT 06611-4552 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2006 |
Last Update Date | 22/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G26570 | (02) | CT |