Basic Information
| Provider Information | |||||||||
| NPI: | 1487692539 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARTIN | ||||||||
| FirstName: | C | ||||||||
| MiddleName: | EDWIN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25 MONUMENT RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174035060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178512441 | ||||||||
| FaxNumber: | 7178124867 | ||||||||
| Practice Location | |||||||||
| Address1: | 25 MONUMENT RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174035060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178512441 | ||||||||
| FaxNumber: | 7178514867 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2006 | ||||||||
| LastUpdateDate: | 10/28/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | MD029013L | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 087061 | 01 | PA | UNISON | OTHER | 20009673 | 01 | PA | AMERIHEALTH MERCY | OTHER | 34592 | 01 | PA | GEISINGER | OTHER | 01514401 | 01 | PA | CAPITAL BLUE CROSS | OTHER | 082382 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 000696499 | 05 | PA | MEDICAID | 1525841 | 01 | PA | GATEWAY | OTHER | 060013258 | 01 | PA | RAILROAD MEDICARE | OTHER | 524716 | 01 | PA | CAREFIRST BLUE CROSS BLUE SHIELD | OTHER |