Provider Demographics
NPI:1386743961
Name:MARTIN, GEORGE T (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:T
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5800 THIRD AVENUE
Mailing Address - Street 2:MANAGED CARE DEPARTMENT
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220
Mailing Address - Country:US
Mailing Address - Phone:718-630-7124
Mailing Address - Fax:718-630-7437
Practice Address - Street 1:150 55TH STREET
Practice Address - Street 2:LMC PHYSICIAN SERVICES, PC
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220
Practice Address - Country:US
Practice Address - Phone:718-630-7000
Practice Address - Fax:718-630-8515
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY115717207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1000034539 004OtherAFFINITY
NY702496OtherUNITED HEALTHCARE
NYP427181OtherOXFORD
NY115717-A79OtherHEALTH FIRST
NY00344812Medicaid
NY000384680101OtherHEALTH PLUS
NY113192423MA10OtherCARE PLUS
NY171903OtherELDERPLAN
NY00115717OtherNEIGHBORHOOD
NY301258OtherWELLCARE