Provider Demographics
NPI:1679696843
Name:MARTIN, ALLAN BRADLEY (MD)
Entity type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:BRADLEY
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:348 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:NJ
Mailing Address - Zip Code:08079-2108
Mailing Address - Country:US
Mailing Address - Phone:856-506-6439
Mailing Address - Fax:609-589-3947
Practice Address - Street 1:348 GRANT ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:NJ
Practice Address - Zip Code:08079-2108
Practice Address - Country:US
Practice Address - Phone:856-506-6439
Practice Address - Fax:609-589-3947
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03465400207QA0505X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJD19276Medicare UPIN
NJ520566QQ1Medicare ID - Type Unspecified