Provider Demographics
NPI:1962886580
Name:MARTIN, MATTHEW GERARD (NP-C)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:GERARD
Last Name:MARTIN
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3838 N CAUSEWAY BLVD STE 2200
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-8306
Mailing Address - Country:US
Mailing Address - Phone:504-849-4500
Mailing Address - Fax:
Practice Address - Street 1:3838 N CAUSEWAY BLVD STE 2200
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-8306
Practice Address - Country:US
Practice Address - Phone:504-849-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-14
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP08397363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily