Provider Demographics
NPI:1366527251
Name:MARTIN, SCOTT RAYMOND (MD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:RAYMOND
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:29 HOSPITAL PLZ STE 502
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-3602
Mailing Address - Country:US
Mailing Address - Phone:203-348-7410
Mailing Address - Fax:203-276-2324
Practice Address - Street 1:29 HOSPITAL PLZ STE 502
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-3602
Practice Address - Country:US
Practice Address - Phone:203-348-7410
Practice Address - Fax:203-276-2324
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY228262207P00000X, 207R00000X, 207RC0000X
MI4301091365207R00000X, 207RC0000X, 207RI0011X
CT54709207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease