Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 034246 | CT |
NPI | 1003842865 |
---|---|
Provider Name | Dr. Thomas V. Martin |
First Address | New Haven, CT 06511-4417 |
Second Address | New Haven, CT 06511-4417 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2006 |
Last Update Date | 22/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F95051 | (02) | CT |