Michael Martin, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

018063 Issued in CT

Practice address

1504 Sullivan Ave
South Windsor, CT 06074-2711

Phone

(860) 644-1523

Fax

(860) 648-9468

NPI assigned

Apr 8, 2006

Last updated

Jun 7, 2010By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Anis & Martin Internal Medicine Associates, LLC

  • Internal Medicine Physician
  • South Windsor, CT
  • NPI 1285675082
  Authorized official Same address or phone
• Eastern Connecticut Medical Professionals Foundation Inc

  dba Eastern CT Medical Professionals

  • Family Medicine Physician
  • Manchester, CT
  • NPI 1770557712

  Internal Medicine

  NPD (past)
• Eastern Connecticut Medical Professionals Foundation, Inc

  dba Eastern Orthopeadics and Sports Medicine, PC

  • Specialist
  • South Windsor, CT
  • NPI 1497864516
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1144454400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1275868800000",
    "number": "1952364341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3136",
            "city": "VERNON",
            "state": "CT",
            "postal_code": "060662036",
            "telephone_number": "860-896-1422",
            "fax_number": "860-896-1425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1504 SULLIVAN AVE",
            "city": "SOUTH WINDSOR",
            "state": "CT",
            "postal_code": "060742711",
            "telephone_number": "860-644-1523",
            "fax_number": "860-648-9468"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "MICHAEL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-08",
        "last_updated": "2010-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CT",
            "license": "018063",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P00087818",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CTCARE",
            "identifier": "018083",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1952364341",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "010018083CT02",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Curtis Manganello, OTR
• Richard John Manganiello, M.D.
• Megan Campbell Marsh, PH.D.
• Morgan Martellio
• Chelsey Martin, APRN
• Brandon Kyle Martinez, PHARMD
• Scott Matson, MD
• McKay Family Therapy, LLC
• Timothy Robert McKay, LMFT
• Kim Elaine McKeon, LCSW

• Internal Medicine Physician in South Windsor, CT
• Providers in South Windsor, CT by specialty
• Internal Medicine Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.