Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 5118 | PA |
NPI | 1184899254 |
---|---|
Provider Name | Dr. Thomas Ellsworth Martin JR. |
First Address | Media, PA 19063-2101 |
Second Address | Media, PA 19063-2101 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2008 |
Last Update Date | 29/04/2008 |