Basic Information
| Provider Information | |||||||||
| NPI: | 1811211592 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARTIN | ||||||||
| FirstName: | ADAM | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 301 CONCOURSE BLVD | ||||||||
| Address2: | SUITE 190 | ||||||||
| City: | GLEN ALLEN | ||||||||
| State: | VA | ||||||||
| PostalCode: | 230595643 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8045494040 | ||||||||
| FaxNumber: | 8045494032 | ||||||||
| Practice Location | |||||||||
| Address1: | 6946 FOREST AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232301701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8045494040 | ||||||||
| FaxNumber: | 8045494032 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2010 | ||||||||
| LastUpdateDate: | 05/31/2019 | ||||||||
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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 | 207N00000X | 0101255973 | VA | Y | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.