Provider Demographics
NPI:1982607792
Name:MARTIN, NEIL F (MD)
Entity type:Individual
Prefix:
First Name:NEIL
Middle Name:F
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 1:5454 WISCONSIN AVE STE 950
Mailing Address - Street 2:
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-6912
Mailing Address - Country:US
Mailing Address - Phone:301-657-5700
Mailing Address - Fax:301-654-9132
Practice Address - Street 1:5454 WISCONSIN AVE
Practice Address - Street 2:STE 950
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-6912
Practice Address - Country:US
Practice Address - Phone:301-657-5700
Practice Address - Fax:301-654-9132
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD12779207W00000X
MDD0026299207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD334651000Medicaid
415408W78Medicare PIN
C68994Medicare UPIN