Provider Demographics
NPI:1902885999
Name:AUSTRIA, MARTIN R (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:R
Last Name:AUSTRIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12920 SUGARBLUFF RD
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34715-6834
Mailing Address - Country:US
Mailing Address - Phone:352-394-6901
Mailing Address - Fax:
Practice Address - Street 1:2100 PREVATT ST
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-6130
Practice Address - Country:US
Practice Address - Phone:352-308-8903
Practice Address - Fax:352-460-0785
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME76165207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL257693700Medicaid
FL1265798870OtherGROUP NPI
FL49878VMedicare PIN
FL49878UMedicare PIN