Jerry Wayne Martin, M.D.
Individual provider Active NPI Family Medicine Physician · Washington, VA
NPI 1992730832 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1992730832
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 0101020616 (VA)
- Practice address
- 338 Gay Street
Suite a
Washington, VA 22747-0269 - Phone
- (540) 675-3316
- Fax
- (540) 675-3692
- NPI assigned
- Jul 11, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20070208000705 | VA | Practitioner - Family Practice | 4587666284 | Practice locations: Washington, VA |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0101020616 | VA | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jerry W. Martin | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 0101020616 | VA | Yes |
Addresses
Primary practice location
338 Gay Street
Suite a
Washington, VA 22747-0269
Mailing address
PO Box 269
Washington, VA 22747-0269
Phone (540) 675-3316
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 175551 | Other | VA | ANTHEM BCBS |
Other providers in Washington, VA
- Basiony Taher Hagar
- Jerry W. Martin
- Nancy Jinkins
- Katherine Warzinski Pmhnp FNP LLC
- Barbara Macdonald
- John Francis McCue
- Miller Family Health & Wellness, PLLC
- Ann Miller
- Mountainside Medicine P.C.
- Mountainside Physical Therapy Inc
All providers in Washington, VA · Family Medicine Physician in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.