Individual
MARY ELLEN MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3400 CIVIC CENTER BLVD, SOUTH PAVILION, 12TH FLOOR, PERELMAN CENTER FOR ADVANCED MEDICINE, PHILADELPHIA, PA 19104
(215) 360-0713
(215) 214-3779
Mailing address
3400 CIVIC CENTER BLVD, SOUTH PAVILION, 12TH FLOOR, PERELMAN CENTER FOR ADVANCED MEDICINE, PHILADELPHIA, PA 19104
(215) 360-0713
(215) 214-3779
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
MD-068066-L
PA
207RH0003X
Hematology & Oncology Physician
Primary
MD068066L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00189880400001
—
PA
Enumeration date
10/12/2005
Last updated
11/03/2016
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