Provider Demographics
NPI:1962406470
Name:MARTIN, GEOFFREY A (MD)
Entity type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:A
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:P.O. BOX 3000
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374
Mailing Address - Country:US
Mailing Address - Phone:800-476-8646
Mailing Address - Fax:919-382-3210
Practice Address - Street 1:1840 AMHERST ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2808
Practice Address - Country:US
Practice Address - Phone:540-536-8000
Practice Address - Fax:540-536-7800
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101264714207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000275811Other12 DIGIT BCBS KY NUMBER
KY1161625OtherPASSPORT GROUP # 1172544
KY64048507Medicaid
KY000000060164Other12 DIGIT BCBS / KY NUMBER
KY50003676OtherPASSPORT GROUP # 50000548
KY50003676OtherPASSPORT GROUP # 50000548
KY1161625OtherPASSPORT GROUP # 1172544
KYH64867Medicare UPIN