Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 36129378 | IL |
N | 207RS0012X | Sleep Medicine | 070921 | GA |
N | 207RS0012X | Sleep Medicine | 36129378 | IL |
Y | 2084N0400X | Neurologist | MD458011 | PA |
NPI | 1063659225 |
---|---|
Provider Name | Dr. Martina Vendrame |
First Address | Upland, PA 19013-3902 |
Second Address | Vidalia, GA 30474-7200 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2009 |
Last Update Date | 28/06/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003139553A | (05) | GA |