Active NPI
Misha Martin, M.D.
- Pediatrics Physician
- Germantown, MD
National Provider Identifier
1124090188
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- D0055283
- Practice address
- 12850 Middlebrook Rd Ste 200
Germantown, MD 20874-5244 - Phone
- (301) 540-5900
- Fax
- (301) 540-8974
- NPI assigned
- Feb 3, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | D0055283 | MD | Primary |
Addresses
Primary practice location
12850 Middlebrook Rd Ste 200
Germantown, MD 20874-5244
Mailing address
12850 Middlebrook Rd Ste 200
Germantown, MD 20874-5244
Phone (301) 540-5900
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 404760500 | Medicaid | MD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D0055283 | MD | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Complete Care for Kids | Past | Accepting new patients | |
| Frederick Health Hospital Inc | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Preferred Provider Organization
- Germantown, MD
- NPI 1285760199
-
- General Acute Care Hospital
- Frederick, MD
- NPI 1538165527
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138924800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1593561600000",
"number": "1124090188",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12850 MIDDLEBROOK RD STE 200",
"city": "GERMANTOWN",
"state": "MD",
"postal_code": "208745244",
"telephone_number": "301-540-5900",
"fax_number": "301-540-8974"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12850 MIDDLEBROOK RD STE 200",
"city": "GERMANTOWN",
"state": "MD",
"postal_code": "208745244",
"telephone_number": "301-540-5900",
"fax_number": "301-540-8974"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTIN",
"first_name": "MISHA",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-02-03",
"last_updated": "2020-07-01",
"certification_date": "2020-07-01",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MD",
"license": "D0055283",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "404760500",
"state": "MD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Germantown, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.