KELLY MARTIN (NPI# 1174767065) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174767065 |
| Entity Type | Individual |
| Full Name | KELLY MARTIN |
| Credential | M.D. |
| Practice Address |
34th Street and Civic Center Boulevard Suite 7c26 Philadelphia PA 19104 |
| Practice Telephone | 2155907430 |
| Mailing Telephone | 2155907430 |
| Enumeration Date | 2009-04-23 |
| Last Update Date | 2012-07-10 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080P0203X |
Pediatrics Specialization: Pediatric Critical Care Medicine |
MT201919 | PA | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578100111 | Kelly Martin | Speech-Language Pathologist | 948 Dinosaur Dr, Erie, CO 80516-6576 | 2019-12-02 |
| 1386298677 | Kelly Marie Martin | Licensed Practical Nurse | 909 S Michael St, Saint Marys, PA 15857-3030 | 2019-07-25 |
| 1477117885 | Kelly Rae Martin | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 13881 Schuelke Beach Rd Nw, Miltona, MN 56354 | 2019-05-01 |
| 1679098727 | Kelly Lynn Martin | Massage Therapist | 6537 Fairlane Dr, Boston, NY 14025-9637 | 2017-08-10 |
| 1891231379 | Kelly Martin | Speech-Language Pathologist | 3513 Indian Oaks Ln, Toledo, OH 43617-3007 | 2017-01-09 |
| 1376900654 | Kelly Ann Martin | Counselor | 5501 Pandale Valley Dr, Mckinney, TX 75071-7721 | 2016-01-18 |
| 1245616481 | Kelly A Martin | Counselor | 8180 Eagle Mountain Cir, Fort Worth, TX 76135-9531 | 2015-08-10 |
| 1316330178 | Kelly Martin | Rehabilitation Practitioner | 12111 N 66th Ave, Glendale, AZ 85304-1625 | 2015-03-17 |
| 1538563077 | Kelly Ann Martin | Counselor | 15208 County Road 1835, Lubbock, TX 79424-8520 | 2014-10-13 |
| 1124430764 | Kelly Michael Martin | Registered Nurse | 1001 S. Gearge St, York, PA 17403 | 2014-06-02 |
| Street Address |
34TH STREET AND CIVIC CENTER BOULEVARD SUITE 7C26 |
| City | PHILADELPHIA |
| State | PA |
| Zip Code | 19104 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174529440 | Ramesh Kodavatiganti | Anesthesiology | 34th Street and Civic Center Boulevard, Suite 9329, Philadelphia, PA 19104-4399 | 2005-06-22 |
| 1619351020 | Rebekah Midberry | Nurse Anesthetist, Certified Registered | 34th Street and Civic Center Boulevard, Suite 9329, Philadelphia, PA 19104-4399 | 2015-07-15 |
| 1851775654 | Elizabeth Worster | Nurse Practitioner | 34th Street and Civic Center Boulevard, Philadelphia, PA 19104 | 2015-07-13 |
| 1013397504 | Lauren Toler | Nurse Anesthetist, Certified Registered | 34th Street and Civic Center Boulevard, Suite 9329, Philadelphia, PA 19104-4399 | 2015-06-01 |
| 1639560709 | Mercedes Vallecillo | Nurse Anesthetist, Certified Registered | 34th Street and Civic Center Boulevard, Suite 9329, Philadelphia, PA 19104-4399 | 2015-02-11 |
| 1023416492 | Cheryl Brenneman | Nurse Practitioner | 34th Street and Civic Center Boulevard, Philadelphia, PA 19104 | 2014-12-16 |
| 1942607270 | Jeanette Zarrella Escarfuller | Nurse Anesthetist, Certified Registered | 34th Street and Civic Center Boulevard, Suite 9329, Philadelphia, PA 19104-4399 | 2014-12-02 |
| 1851798854 | Kristen Dalton | Nurse Practitioner | 34th Street and Civic Center Boulevard, Philadelphia, PA 19104 | 2014-11-20 |
| 1720487002 | Bobbie Hawkins | Nurse Practitioner | 34th Street and Civic Center Boulevard, Philadelphia, PA 19104 | 2014-08-22 |
| 1801295522 | Meghan Yowell | Registered Nurse | 34th Street and Civic Center Boulevard, Philadelphia, PA 19104 | 2014-08-19 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639770829 | Michelle Morris | Student in an Organized Health Care Education/Training Program | Dept. of Family Medicine & Community Health, 3737 Market, Philadelphia, PA 19104 | 2020-11-04 |
| 1346853041 | Spectrum Health Services, Inc. | Clinic/Center | 1415 South University Ave, Philadelphia, PA 19104 | 2020-08-24 |
| 1770104259 | Fatimah Sorefan-mangou | Student in an Organized Health Care Education/Training Program | 4 Maloney 3400 Spruce Street, Philadelphia, PA 19104 | 2020-05-06 |
| 1114548690 | Rebecca Blaguski | Registered Nurse | The Hospital of The University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104 | 2020-05-06 |
| 1952944175 | Rebecca Miriam Barmherzig | Psychiatry & Neurology | 3501 Civic Centre Blvd, 10th Flr Ctrb, Neurology, Philadelphia, PA 19104 | 2019-10-21 |
| 1891257101 | James Paul Byrne | Surgery | Penn Presbyterian Medical Center, Division of Trauma, S, 51 N. 39th Street, Suite 120, 1st Floor Medical Office, Philadelphia, PA 19104 | 2019-04-04 |
| 1093276453 | Lauren Shreve | Student in an Organized Health Care Education/Training Program | Department of Surgery, Surgery Education - Penn Health, 3400 Spruce Street, 4 Maloney, Philadelphia, PA 19104 | 2019-03-28 |
| 1285194282 | Lauren M Christie | Student in an Organized Health Care Education/Training Program | Penn Presbyterian Medical Center, 51 N. 39th Street, Philadelphia, PA 19104 | 2019-03-25 |
| 1114487683 | Sabrina Layne | Student in an Organized Health Care Education/Training Program | 3400 Spruce Street, 100 Centrex, Philadelphia, PA 19104 | 2019-03-21 |
| 1811457310 | Kia Lor | Student in an Organized Health Care Education/Training Program | Hospital of University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104 | 2019-03-21 |
| Find all providers in zip 19104 | ||||
| Taxonomy Code | 2080P0203X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Pediatric Critical Care Medicine |
| A pediatrician expert in advanced life support for children from the term or near-term neonate to the adolescent. This competence extends to the critical care management of life-threatening organ system failure from any cause in both medical and surgical patients and to the support of vital physiological functions. This specialist may have administrative responsibilities for intensive care units and also facilitates patient care among other specialists. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition changed, source added] Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. ACGME Accredited Residency Program Requirements: 2 years of training with 3 years Pediatrics plus 1 year Pediatric Critical Care for certification for a total of 6 years. ABMS Approved Subspecialty Certificate (Pediatrics) |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093039893 | Charlotte Zahara Woods-hill | Pediatrics | 3401 Civic Center Bvd, Suite 9329, Philadelphia, PA 19104-4319 | 2010-03-23 |
| 1790910339 | Amir Bar | Pediatrics | 160 E. Erie Ave, Philadelphia, PA 19134 | 2009-05-27 |
| 1528149150 | Arun Chopra | Pediatrics | Front and Erie St, St. Christopher's Hospital for Children, Philadelphia, PA 19134 | 2006-10-18 |
| 1750331278 | Sharon Calaman | Pediatrics | St.christophers Hospital for Children, Erie Ave At Front Street, Philadelphia, PA 19134-1095 | 2006-05-12 |
| 1699739599 | Paul Michael Shore | Pediatrics | 3601 A Street, Philadelphia, PA 19134 | 2006-04-17 |
| 1639142086 | Robert A Berg | Pediatrics | 324 S. 34th Street, Suite 9329, Philadelphia, PA 19104-4399 | 2006-02-08 |
| 1114919040 | Gabriel Hauser | Pediatrics | 160 E Erie Ave, Philadelphia, PA 19134-1011 | 2005-08-17 |
| 1083232557 | Riane Goodwin | Pediatrics | 3401 Civic Center Blvd, Philadelphia, PA 19104-4319 | 2020-07-10 |
| 1518501733 | Stc Pediatrics LLC | Pediatrics | 160 E Erie Ave, Philadelphia, PA 19134-1011 | 2019-10-31 |
| 1750944500 | Natalie Horvatinovic | Pediatrics | 3401 Civic Center Blvd, Philadelphia, PA 19104-4319 | 2019-04-17 |
| Find all providers in PHILADELPHIA | ||||
| City | PHILADELPHIA |
| Zip Code | 19104 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.