Individual
MAC T MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1215 LEE ST, CHARLOTTESVILLE, VA 22908-0816
(434) 924-9400
Mailing address
PO BOX 9007, CHARLOTTESVILLE, VA 22906-9007
(434) 295-1000
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
0102208375
VA
2085R0202X
Diagnostic Radiology Physician
1859
NE
2085R0202X
Diagnostic Radiology Physician
20A22422
CA
Other
Enumeration date
06/19/2017
Last updated
08/02/2024
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