Provider Demographics
NPI:1306177043
Name:MARTIN, JOHN HARVEY SR (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:HARVEY
Last Name:MARTIN
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:160 LAKESIDE LN
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-2074
Mailing Address - Country:US
Mailing Address - Phone:610-359-9839
Mailing Address - Fax:610-359-9839
Practice Address - Street 1:160 LAKESIDE LN
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-2074
Practice Address - Country:US
Practice Address - Phone:610-359-9839
Practice Address - Fax:610-359-9839
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-20
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD026799L207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAD68616Medicare PIN