Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 28804 | SC |
N | 2081P2900X | Pain Medicine | 28804 | SC |
NPI | 1083642045 |
---|---|
Provider Name | Dr. Jennifer P. Martin |
First Address | Greenville, SC 29615-4816 |
Second Address | Greenville, SC 29615-4816 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2006 |
Last Update Date | 11/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
288049 | (05) | SC |
8157 | MEDICARE PTAN (01) | SC |
I54637 | (02) | SC |