Individual
STEPHANIE RENEE MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2401 BRANDERMILL BLVD, SUITE 250, GAMBRILLS, MD 21054-1690
(410) 721-1507
(410) 721-1510
Mailing address
PO BOX 12622, BELFAST, ME 04915-4017
(443) 481-6576
(443) 481-6515
Taxonomy
Speciality
Code
Description
License number
State
207RS0010X
Sports Medicine (Internal Medicine) Physician
Primary
D73127
MD
390200000X
Student in an Organized Health Care Education/Training Program
0116019263
VA
390200000X
Student in an Organized Health Care Education/Training Program
C7-0004604
DE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
053826400
—
MD
01
—
8527802
AETNA HMO
MD
01
—
97725101
BCBS
MD
01
—
9936846
AETNA PPO
MD
01
—
K6440003
BCBS
DC
Enumeration date
06/28/2007
Last updated
04/01/2015
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