Provider Demographics
NPI:1144274887
Name:MARTIN, DAVID (CRNA)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:MARTIN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:262 FIELD CLUB CIR
Mailing Address - Street 2:
Mailing Address - City:MC KEES ROCKS
Mailing Address - State:PA
Mailing Address - Zip Code:15136-1033
Mailing Address - Country:US
Mailing Address - Phone:412-788-4022
Mailing Address - Fax:
Practice Address - Street 1:4727 FRIENDSHIP AVE
Practice Address - Street 2:#240
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-1770
Practice Address - Country:US
Practice Address - Phone:412-235-5870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV63439367500000X
MDR203872367500000X
PARN282715L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2469047Medicaid
MD412170800Medicaid
PA0017269590004Medicaid
WV3810008149Medicaid
WV3810008149Medicaid
WVMA6035421Medicare PIN