Individual
DR. JACK T. MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4518 UNION DEPOSIT RD, HARRISBURG, PA 17111-2910
(717) 652-5840
(717) 652-8152
Mailing address
4520 UNION DEPOSIT RD, HARRISBURG, PA 17111-2910
(717) 652-6105
(717) 652-8152
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
MD063451L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0017475650001
—
PA
01
—
453061
HIGHMARK BLUE SHIELD
PA
01
—
50084215
CAPITAL BLUE CROSS
PA
Enumeration date
05/11/2006
Last updated
03/07/2023
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