Provider Demographics
NPI:1306501986
Name:MARTIN, CAMERON ISAAC
Entity type:Individual
Prefix:
First Name:CAMERON
Middle Name:ISAAC
Last Name:MARTIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 OAKLAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-3224
Mailing Address - Country:US
Mailing Address - Phone:803-412-9964
Mailing Address - Fax:
Practice Address - Street 1:700 0AKLAND AVENUE
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-2973
Practice Address - Country:US
Practice Address - Phone:803-412-9964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-08
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer