Provider Demographics
NPI:1154407732
Name:MARTIN, GEORGE RANDOLPH (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:RANDOLPH
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4944 GREENSBORO RD
Mailing Address - Street 2:
Mailing Address - City:RIDGEWAY
Mailing Address - State:VA
Mailing Address - Zip Code:24148-3390
Mailing Address - Country:US
Mailing Address - Phone:276-956-2233
Mailing Address - Fax:276-956-1629
Practice Address - Street 1:4944 GREENSBORO RD
Practice Address - Street 2:
Practice Address - City:RIDGEWAY
Practice Address - State:VA
Practice Address - Zip Code:24148-3390
Practice Address - Country:US
Practice Address - Phone:276-956-2233
Practice Address - Fax:276-956-1629
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA01012388252084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC68891Medicare UPIN
VA009667S58Medicare ID - Type Unspecified