Provider Demographics
NPI:1104883693
Name:MARTIN, ANDREW J (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:J
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3730 KIRBY DR
Mailing Address - Street 2:STE 1200
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-3905
Mailing Address - Country:US
Mailing Address - Phone:281-888-8999
Mailing Address - Fax:
Practice Address - Street 1:12610 E NORTHWEST HWY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75228-8010
Practice Address - Country:US
Practice Address - Phone:469-518-5584
Practice Address - Fax:844-846-8853
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4664582085R0202X
AZ660802085R0202X
SC268662085R0202X
TXM23932085R0202X, 2085R0204X
ARE-140512085R0202X, 2085R0204X
NJ25MA115138002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX84714SOtherBLUE CROSS BLUE SHIELD TX
TXI07945Medicare UPIN
TX8G3185Medicare ID - Type Unspecified