Individual
DR. MARTIN JOHN KRESHON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1640 E ROOSEVELT BLVD, MONROE, NC 28112-4017
(704) 226-0599
(704) 226-0599
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 343-9800
(704) 347-2011
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
19297
SC
207RC0000X
Cardiovascular Disease Physician
Primary
34065
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5031B
BCBS
NC
05
—
895031B
—
NC
05
—
N34065
—
SC
01
—
P00612427
RR MEDICARE
NC
01
—
P00728483
RR MEDICARE SANGER
NC
Enumeration date
06/01/2006
Last updated
10/25/2020
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