Provider Demographics
NPI:1003817420
Name:MARTUCCIO, JAMES V JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:V
Last Name:MARTUCCIO
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:302 NILES CORTLAND RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484
Mailing Address - Country:US
Mailing Address - Phone:330-395-2020
Mailing Address - Fax:330-395-6200
Practice Address - Street 1:302 NILES CORTLAND RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484
Practice Address - Country:US
Practice Address - Phone:330-395-2020
Practice Address - Fax:330-395-6200
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-05-7140-M207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0822024Medicaid
OH0692522Medicare PIN
E84843Medicare UPIN