Individual
TIMOTHY JOHN MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2255
(336) 716-7994
Mailing address
PO BOX 344, WINSTON SALEM, NC 27102-0344
(336) 716-2255
(336) 716-7994
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
34084
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3500
PARTNERS
NC
01
—
45602
MEDCOST
NC
01
—
54429
BCBS
NC
01
—
5735102
AETNA
—
05
—
6324207
—
VA
05
—
8954429
—
NC
05
—
9840171000
—
WV
05
—
Q34084
—
SC
Enumeration date
11/28/2005
Last updated
08/20/2010
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