Provider Demographics
NPI:1861539223
Name:MARTIN, SAUL AVRUM (MD)
Entity type:Individual
Prefix:DR
First Name:SAUL
Middle Name:AVRUM
Last Name:MARTIN
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 1:345 BLACKSTONE BLVD
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-4861
Mailing Address - Country:US
Mailing Address - Phone:401-272-4057
Mailing Address - Fax:401-455-6293
Practice Address - Street 1:345 BLACKSTONE BLVD
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-4861
Practice Address - Country:US
Practice Address - Phone:401-272-4057
Practice Address - Fax:401-455-6293
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD053652084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI215626OtherBLUE CROSS
RI001417OtherBLUE CHIP
C89824Medicare UPIN