Provider Demographics
NPI:1194713511
Name:MARTIN, GERALD B (MD)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:B
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 1:64 S WEST ST
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17013
Mailing Address - Country:US
Mailing Address - Phone:717-245-2291
Mailing Address - Fax:717-245-9652
Practice Address - Street 1:64 S WEST ST
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17013
Practice Address - Country:US
Practice Address - Phone:717-245-2291
Practice Address - Fax:717-245-9652
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD018607E207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01645901OtherCAIC
C31969Medicare UPIN
PA641642Medicare ID - Type Unspecified
149822G0DMedicare PIN
060040410OtherMEDICARE RAILROAD PIN
PA000858425Medicaid