Provider Demographics
NPI:1154375210
Name:PINSTEIN, MARTIN L (MD)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:L
Last Name:PINSTEIN
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:PO BOX 171206
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38187-1206
Mailing Address - Country:US
Mailing Address - Phone:901-765-3212
Mailing Address - Fax:901-765-1727
Practice Address - Street 1:5959 PARK AVE
Practice Address - Street 2:RADIOLOGY DEPARTMENT
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-5200
Practice Address - Country:US
Practice Address - Phone:901-765-3212
Practice Address - Fax:901-765-1727
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0091512085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201192226Medicaid
AR106865001Medicaid
MS00120140Medicaid
TN3037476Medicaid
MS00120140Medicaid
TN3037475Medicare ID - Type Unspecified