Provider Demographics
NPI:1619961976
Name:FIALA, MARTIN J (MD)
Entity type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:J
Last Name:FIALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1816 N WASHINGTON ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-2222
Mailing Address - Country:US
Mailing Address - Phone:931-455-8676
Mailing Address - Fax:931-455-9983
Practice Address - Street 1:1816 N WASHINGTON ST
Practice Address - Street 2:SUITE 100
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-2222
Practice Address - Country:US
Practice Address - Phone:931-455-8676
Practice Address - Fax:931-455-9983
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD26680207X00000X, 208100000X, 2086S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
0940299OtherUNITED HEALTH CARE
TN3093522OtherBLUE CROSS
682362OtherAETNA
200034386OtherRAILROAD MEDICARE
621738887002OtherPRUDENTIAL
TNTN0102OtherAMERICHOICE
TN10070490OtherAMERIGROUP
1536928OtherUMWA
TN3098802Medicaid
5541521OtherCIGNA
TN3098802Medicaid
TNTN0102OtherAMERICHOICE
682362OtherAETNA