Provider Demographics
NPI:1205969193
Name:FOX, MARTIN (MD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:
Last Name:FOX
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 1:1 STRAWBERRY HILL COURT
Mailing Address - Street 2:REGENCY TOWERS APT # 4H
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902
Mailing Address - Country:US
Mailing Address - Phone:203-325-3575
Mailing Address - Fax:203-352-3580
Practice Address - Street 1:1 STRAWBERRY HILL COURT
Practice Address - Street 2:REGENCY TOWERS APT # 4H
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902
Practice Address - Country:US
Practice Address - Phone:203-325-3575
Practice Address - Fax:203-352-3580
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT10602207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1106020Medicaid
CT1106020Medicaid
D02430Medicare UPIN