Basic Information
| Provider Information | |||||||||
| NPI: | 1821408568 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARTIN | ||||||||
| FirstName: | COREY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2411 W BELVEDERE AVE STE 504 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212155232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106018331 | ||||||||
| FaxNumber: | 4106015389 | ||||||||
| Practice Location | |||||||||
| Address1: | 2411 W BELVEDERE AVE STE 504 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212155232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106018331 | ||||||||
| FaxNumber: | 4106015389 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2014 | ||||||||
| LastUpdateDate: | 11/04/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 2080P0214X | D90361 | MD | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Pulmonology |
No ID Information.