Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MD-064255-L | PA |
N | 207QA0505X | Family Doctor - Adult Medicine | MD-064255-L | PA |
N | 207QG0300X | Family Doctor - Geriatric Medicine | MD-064255-L | PA |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | MD-064255-L | PA |
N | 207QS0010X | Family Doctor - Sports Medicine | MD-064255-L | PA |
NPI | 1598763823 |
---|---|
Provider Name | James L. Martin |
First Address | Allentown, PA 18103-7933 |
Second Address | Allentown, PA 18103-7933 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2005 |
Last Update Date | 08/10/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000462277 | INDEPENDENCE BLUECROSS (01) | PA |
02995501 | CAPITAL BLUECROSS (01) | PA |
080187099 | RAILROAD MEDICARE (01) | PA |
A64241 | (02) | |
MA462277 | HIGHMARK BLUESHIELD (01) | PA |