Individual
KENNETH WADE MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
160 E ERIE AVE, PHILADELPHIA, PA 19134-1011
(215) 427-5234
Mailing address
PO BOX 13579, READING, PA 19612-3579
(484) 628-1324
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
MD479412
PA
2085R0202X
Diagnostic Radiology Physician
G59973
CA
2085R0202X
Diagnostic Radiology Physician
Primary
MD479412
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G599730
—
CA
01
—
P00247201
RAILROAD MEDICARE PIN
—
Enumeration date
06/05/2006
Last updated
05/22/2024
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