Basic Information
| Provider Information | |||||||||
| NPI: | 1588926455 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARTIN | ||||||||
| FirstName: | ADAM | ||||||||
| MiddleName: | ROSS | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1611 NW 12TH AVE # WW279 | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331361005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055858178 | ||||||||
| FaxNumber: | 3055855743 | ||||||||
| Practice Location | |||||||||
| Address1: | 1611 NW 12TH AVE # WW279 | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331361005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055858178 | ||||||||
| FaxNumber: | 3055855743 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2012 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 0116024785 | VA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 2085N0700X | ME134624 | FL | Y | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology |
No ID Information.