Individual
MR. TIMOTHY WALTER MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2001 VAIL AVE, ANESTHESIA DEPARTMENT, CHARLOTTE, NC 28207-1219
(704) 304-5995
Mailing address
PO BOX 60499, ANESTHESIA DEPARTMENT, CHARLOTTE, NC 28260-0499
(704) 304-6202
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
176128
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8052812
—
NC
05
—
NAN760
—
SC
Enumeration date
01/16/2007
Last updated
06/30/2008
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