Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 146740 | NY |
NPI | 1003877598 |
---|---|
Provider Name | Dr. Michael G. Martin |
First Address | Pittsford, NY 14534-3503 |
Second Address | Rochester, NY 14623-1606 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2006 |
Last Update Date | 08/07/2007 |