Provider Demographics
NPI:1720072309
Name:MARTIN, DENNIS KEITH (MD)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:KEITH
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 1:801 MCCARTHY BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-5237
Mailing Address - Country:US
Mailing Address - Phone:252-633-3942
Mailing Address - Fax:252-633-3332
Practice Address - Street 1:801 MCCARTHY BLVD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-5237
Practice Address - Country:US
Practice Address - Phone:252-633-3942
Practice Address - Fax:252-633-3332
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23863207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8954152Medicaid
NC208526BMedicare ID - Type UnspecifiedMEDICARE PROVIDER #
NC8954152Medicaid