Basic Information
| Provider Information | |||||||||
| NPI: | 1508229212 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARTIN | ||||||||
| FirstName: | BRANDON | ||||||||
| MiddleName: | BRYCE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 670 LAWN AVE # 4 | ||||||||
| Address2: | |||||||||
| City: | SELLERSVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 189601571 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2152570414 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 670 LAWN AVE # 4 | ||||||||
| Address2: | |||||||||
| City: | SELLERSVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 189601571 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2152570414 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2016 | ||||||||
| LastUpdateDate: | 06/10/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VX0000X | MD470305 | PA | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Obstetrics | 208D00000X | MD470305 | PA | N | Allopathic & Osteopathic Physicians | General Practice | 207V00000X | MD470305 | PA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.