Individual
KEVIN L MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
114 WOODLAND ST, DEPARTMENT OF SURGERY, HARTFORD, CT 06105-1208
(860) 714-6581
(860) 714-8311
Mailing address
7 STONEGATE DR, WETHERSFIELD, CT 06109-3653
(860) 714-6581
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
002579
CT
363AS0400X
Surgical Physician Assistant
PA4019
MA
Other
Enumeration date
08/07/2009
Last updated
08/31/2011
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