Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NR0200X | Radiology | 1364 | OH |
N | 213ER0200X | Radiology | 1364 | OH |
Y | 111NR0200X | Radiology | 960 | NH |
Y | 213ER0200X | Radiology | 960 | NH |
N | 111NR0200X | Radiology | CHIR009086 | GA |
N | 213ER0200X | Radiology | CHIR009086 | GA |
NPI | 1699817130 |
---|---|
Provider Name | Dr. Jan Martensen |
First Address | Wolfeboro, NH 03894-4324 |
Second Address | Wolfeboro, NH 03894-4328 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2007 |
Last Update Date | 06/01/2016 |