Provider Demographics
NPI:1316995269
Name:MARTIN, EDWARD JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:JOSEPH
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:PO BOX 355
Mailing Address - Street 2:
Mailing Address - City:SLINGERLANDS
Mailing Address - State:NY
Mailing Address - Zip Code:12159-0355
Mailing Address - Country:US
Mailing Address - Phone:518-818-1302
Mailing Address - Fax:
Practice Address - Street 1:246 NEW SCOTLAND AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3101
Practice Address - Country:US
Practice Address - Phone:518-482-4407
Practice Address - Fax:518-482-4408
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2017-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY102850207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY70373OtherEMPIRE BC/BS
NY000405848OtherBLUE SHIELD OF NENY
NY400621OtherMVP HEALTH CARE
NY10001298OtherCDPHP
NY70373OtherEMPIRE BC/BS
NY10001298OtherCDPHP
NY31573BMedicare ID - Type Unspecified