Individual
EDWARD B MARTIN - CHAFEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1200 SIXTH AVE N, ST CLOUD, MN 56303-2735
(320) 251-2700
(320) 240-2118
Mailing address
1200 SIXTH AVE N, ST CLOUD, MN 56303-2735
(320) 251-2700
(320) 240-2118
Taxonomy
Speciality
Code
Description
License number
State
2080N0001X
Neonatal-Perinatal Medicine Physician
34891
MN
2080P0202X
Pediatric Cardiology Physician
Primary
34891
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
074563400
MEDICAL ASSISTANCE (MA)
—
05
—
074563400
—
MN
01
—
1012096
PREFERRED ONE
—
01
—
115598
U-CARE
—
01
—
1207854
MEDICA HEALTH PLANS
—
01
—
370015977
RR MEDICARE
—
01
—
4700063P
MEDICA HEALTH PLANS
—
01
—
51G94MA
BLUE CROSS BLUE SHIELD
—
01
—
690476
FIRST HEALTH PLAN
—
01
—
90051
ARAZ GROUP/AMERICA'S PPO
—
01
—
CQ2388
RR MEDICARE
—
01
—
HP20318
HEALTH PARTNERS
—
Enumeration date
08/30/2005
Last updated
03/23/2015
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