Individual
PHILIP L MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2801 BLUE RIDGE RD, SUITE 200, RALEIGH, NC 27607-6474
(919) 571-0081
(919) 787-3591
Mailing address
2801 BLUE RIDGE RD, SUITE 200, RALEIGH, NC 27607-6474
(919) 571-0081
(919) 787-3591
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
19021
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
180005116
RAILROAD MEDICARE
NC
01
—
54270
BCBS PROVIDER #
NC
01
—
561420397
TAX ID#
NC
05
—
8954270
—
NC
Enumeration date
02/08/2007
Last updated
06/22/2010
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