Provider Demographics
NPI:1871596056
Name:JOHN, MARTHA D (MD)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:D
Last Name:JOHN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:11279 PERRY HWY
Mailing Address - Street 2:STE 450
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-9303
Mailing Address - Country:US
Mailing Address - Phone:724-933-1100
Mailing Address - Fax:724-933-1160
Practice Address - Street 1:604 EPSILON DR
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15238-2808
Practice Address - Country:US
Practice Address - Phone:412-967-9090
Practice Address - Fax:412-967-0186
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2018-12-05
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Provider Licenses
StateLicense IDTaxonomies
PAMD022955E208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009249410003Medicaid
PAC30001Medicare UPIN