Basic Information
| Provider Information | |||||||||
| NPI: | 1346286366 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARTIN | ||||||||
| FirstName: | CHRISTIAN | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 520 N DEKALB ST STE B | ||||||||
| Address2: | |||||||||
| City: | SHELBY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281504191 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7044848001 | ||||||||
| FaxNumber: | 7044842485 | ||||||||
| Practice Location | |||||||||
| Address1: | 520 N DEKALB ST STE B | ||||||||
| Address2: | |||||||||
| City: | SHELBY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281504191 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7044848001 | ||||||||
| FaxNumber: | 7044842485 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2006 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 200100413 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 89126G9 | 05 | NC | MEDICAID | 1282M | 01 | NC | BCBS OF NC | OTHER |