Provider Demographics
NPI:1992373856
Name:MARTIN, DUSTIN JAMES (DO)
Entity type:Individual
Prefix:
First Name:DUSTIN
Middle Name:JAMES
Last Name:MARTIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5241 BUFFALO RD
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16510-2391
Mailing Address - Country:US
Mailing Address - Phone:814-877-7686
Mailing Address - Fax:814-877-7692
Practice Address - Street 1:5241 BUFFALO RD
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16510-2391
Practice Address - Country:US
Practice Address - Phone:814-877-7686
Practice Address - Fax:814-877-7692
Is Sole Proprietor?:No
Enumeration Date:2021-06-16
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS023943207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine