Provider Demographics
NPI:1487692539
Name:MARTIN, C EDWIN (MD)
Entity type:Individual
Prefix:
First Name:C
Middle Name:EDWIN
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 MONUMENT RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-5060
Mailing Address - Country:US
Mailing Address - Phone:717-851-2441
Mailing Address - Fax:717-812-4867
Practice Address - Street 1:25 MONUMENT RD
Practice Address - Street 2:SUITE 200
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-5060
Practice Address - Country:US
Practice Address - Phone:717-851-2441
Practice Address - Fax:717-851-4867
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD029013L207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA087061OtherUNISON
PA20009673OtherAMERIHEALTH MERCY
PA34592OtherGEISINGER
PA01514401OtherCAPITAL BLUE CROSS
PA082382OtherHIGHMARK BLUE SHIELD
PA000696499Medicaid
PA1525841OtherGATEWAY
PA060013258OtherRAILROAD MEDICARE
PA524716OtherCAREFIRST BLUE CROSS BLUE SHIELD
PA20009673OtherAMERIHEALTH MERCY
PA524716OtherCAREFIRST BLUE CROSS BLUE SHIELD