Provider Demographics
NPI:1043261266
Name:PIMENTEL, MARTHA (MD)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:PIMENTEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 MOUNT PLEASANT RD
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06470-1443
Mailing Address - Country:US
Mailing Address - Phone:845-628-2015
Mailing Address - Fax:845-628-2483
Practice Address - Street 1:172 MOUNT PLEASANT RD
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:CT
Practice Address - Zip Code:06470-1443
Practice Address - Country:US
Practice Address - Phone:845-628-2015
Practice Address - Fax:845-628-2483
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT034706208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001347063Medicaid
CT2V8451OtherHEALTH NET
CTP434110OtherOXFORD
CT1262509OtherAETNA US HEALTHCARE
CT7994115OtherCIGNA
CT1367473OtherUNITED HEALTHCARE
CT810774517OtherPHCS
F40392Medicare UPIN
CT001347063Medicaid