Provider Demographics
NPI:1699745919
Name:EARLE, MARTIN (MD)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:
Last Name:EARLE
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 1:1907 LEBANON CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:WEST MIFFLIN
Mailing Address - State:PA
Mailing Address - Zip Code:15122-2432
Mailing Address - Country:US
Mailing Address - Phone:412-563-8100
Mailing Address - Fax:412-653-8120
Practice Address - Street 1:1907 LEBANON CHURCH RD
Practice Address - Street 2:
Practice Address - City:WEST MIFFLIN
Practice Address - State:PA
Practice Address - Zip Code:15122-2432
Practice Address - Country:US
Practice Address - Phone:412-653-8100
Practice Address - Fax:412-563-8120
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD027013E207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000863050Medicaid
PA11024543EOtherCAQH
PA087303UUEMedicare PIN
PAC29430Medicare UPIN
PAP00291482Medicare PIN