Provider Demographics
NPI:1043265721
Name:MARTIN, JOHN P (DO)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:P
Last Name:MARTIN
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:350 BONAR AVE
Mailing Address - Street 2:
Mailing Address - City:WAYNESBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15370-1608
Mailing Address - Country:US
Mailing Address - Phone:724-627-3101
Mailing Address - Fax:724-627-1994
Practice Address - Street 1:220 GREENE PLZ
Practice Address - Street 2:
Practice Address - City:WAYNESBURG
Practice Address - State:PA
Practice Address - Zip Code:15370-8144
Practice Address - Country:US
Practice Address - Phone:724-627-8582
Practice Address - Fax:724-627-7756
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2024-06-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PA0S012587207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA019554449Medicaid
H83234Medicare UPIN
069485EB4Medicare PIN