Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | C1-0006640 | DE |
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | D0059096 | MD |
N | 2086S0122X | Plastic and Reconstructive Surgery | C1-0006640 | DE |
N | 2086S0122X | Plastic and Reconstructive Surgery | D0059096 | MD |
NPI | 1235170572 |
---|---|
Provider Name | David V. Martini |
First Address | Lancaster, PA 17604-8571 |
Second Address | Elkton, MD 21921-6435 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2006 |
Last Update Date | 18/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1235170572 | INDIVIDUAL MEDICAID ID (01) | DE |
1508811928 | GROUP MEDICAID ID (01) | DE |
248471 | GROUP MEDICARE PTAN (01) | DE |
248474YJQX | INDIVIDUAL MEDICARE PTAN (01) | DE |
405979400 | GROUP MEDICAID ID (01) | MD |
500M | GROUP MEDICARE PTAN (01) | MD |
500M759F | INDIVIDUAL MEDICARE PTAN (01) | MD |
512502200 | INDIVIDUAL MEDICAID ID (01) | MD |
P00209459 | MEDICARE RAILROAD (01) | MD |