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Individual

MICHAEL MARTIN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1504 SULLIVAN AVE, SOUTH WINDSOR, CT 06074-2711
(860) 644-1523
(860) 648-9468
Mailing address
PO BOX 3136, VERNON, CT 06066-2036
(860) 896-1422
(860) 896-1425

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
018063
CT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
010018083CT02
ANTHEM
CT
01
018083
CTCARE
CT
05
1952364341
CT
01
P00087818
MEDICARE RAILROAD
CT
Enumeration date
04/08/2006
Last updated
06/07/2010
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