Basic Information
| Provider Information | |||||||||
| NPI: | 1790871648 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HRYNICK | ||||||||
| FirstName: | MARTIN | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1820 | ||||||||
| Address2: | |||||||||
| City: | PRESQUE ISLE | ||||||||
| State: | ME | ||||||||
| PostalCode: | 047691820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077647529 | ||||||||
| FaxNumber: | 2077646504 | ||||||||
| Practice Location | |||||||||
| Address1: | 226 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | SHERMAN | ||||||||
| State: | ME | ||||||||
| PostalCode: | 047763064 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2073654335 | ||||||||
| FaxNumber: | 2073654336 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2006 | ||||||||
| LastUpdateDate: | 05/09/2017 | ||||||||
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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 | 208D00000X | MD11485 | ME | Y | Allopathic & Osteopathic Physicians | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 027976 | 01 | ME | ANTHEM STAR # | OTHER | 080173483 | 01 | ME | RAILROAD MEDICARE NUMBER | OTHER | 10902818 | 01 | ME | CAQH | OTHER | 1790871648 | 05 | ME | MEDICAID |