Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213ES0103X | Foot & Ankle Surgery | 1484 | MA |
Y | 213ES0103X | Foot & Ankle Surgery | 36.004003 | OH |
N | 213ES0103X | Foot & Ankle Surgery | SC007153 | PA |
NPI | 1083111207 |
---|---|
Provider Name | John Andrew Martucci |
First Address | Boston, MA 02215-5324 |
Second Address | Youngstown, OH 44512-6244 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2018 |
Last Update Date | 03/06/2021 |