Provider Demographics
NPI:1730849613
Name:MARTIN ORTHOPAEDIC & WELLNESS GROUP
Entity type:Organization
Organization Name:MARTIN ORTHOPAEDIC & WELLNESS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JABARI
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:202-491-4191
Mailing Address - Street 1:2111 GARDEN GROVE LN
Mailing Address - Street 2:
Mailing Address - City:MITCHELLVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-1884
Mailing Address - Country:US
Mailing Address - Phone:202-491-4191
Mailing Address - Fax:
Practice Address - Street 1:7525 GREENWAY CENTER DR STE 214
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3525
Practice Address - Country:US
Practice Address - Phone:443-333-9667
Practice Address - Fax:443-339-4056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-20
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD2C3026Medicaid