Individual
THOMAS MICHAEL MARTIN
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
RPT
Contact information
Practice address
39 WINDSOR DR, BRIDGEPORT, WV 26330
(304) 842-3137
(304) 842-3138
Mailing address
39 WINDSOR DR, BRIDGEPORT, WV 26330-2807
(304) 842-3137
(304) 842-3138
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
000437
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01071873100
WORKERS' COMPENSATION
WV
01
—
1382862
UMWA
WV
01
—
33664
HEALTH ASSURANCE
WV
01
—
398792
OPTIMUM CHOICE
WV
01
—
5235074
AETNA
WV
05
—
7301125000
—
WV
01
—
WV51916B
HEALTH PLAN
WV
Enumeration date
06/08/2005
Last updated
07/08/2007
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