Basic Information
| Provider Information | |||||||||
| NPI: | 1801096821 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARTIN | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | THOMAS | ||||||||
| NamePrefix: | |||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3209 COLONIAL DR | ||||||||
| Address2: | FAMILY MEDICINE ATTN PATIENT CARE | ||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292036930 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8034346116 | ||||||||
| FaxNumber: | 8034347231 | ||||||||
| Practice Location | |||||||||
| Address1: | 3209 COLONIAL DR | ||||||||
| Address2: | FAMILY MEDICINE ATTN PATIENT CARE | ||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292036930 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8034346116 | ||||||||
| FaxNumber: | 8034347231 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2007 | ||||||||
| LastUpdateDate: | 12/27/2007 | ||||||||
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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 | 207Q00000X | LL1085 | SC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.