Provider Demographics
NPI:1861543696
Name:JEFFREY E MARTIN MD
Entity type:Organization
Organization Name:JEFFREY E MARTIN MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:E
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-892-7055
Mailing Address - Street 1:4 SCAMMAN ST SUITE 19
Mailing Address - Street 2:PMB 2700
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072
Mailing Address - Country:US
Mailing Address - Phone:207-892-7055
Mailing Address - Fax:207-893-1215
Practice Address - Street 1:744 ROOSEVELT TRL
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:ME
Practice Address - Zip Code:04062-5282
Practice Address - Country:US
Practice Address - Phone:207-892-7055
Practice Address - Fax:207-893-1215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2008-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME116530000Medicaid
MEM746OtherCIGNA
ME116530000Medicaid
MEMM9467Medicare PIN