Provider Demographics
NPI:1063451201
Name:DEMARTINI, PAUL DEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:DEAN
Last Name:DEMARTINI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 KINGS HWY E
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825-4867
Mailing Address - Country:US
Mailing Address - Phone:203-382-1900
Mailing Address - Fax:203-382-0019
Practice Address - Street 1:501 KINGS HWY E
Practice Address - Street 2:SUITE 112
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06825-4867
Practice Address - Country:US
Practice Address - Phone:203-382-1900
Practice Address - Fax:203-382-0019
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0243782086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTZS218OtherOXFORD
CT010024378CT01OtherANTHEM BLUE CROSS
CT001243781Medicaid
CT0V5159OtherHEALTH NET
CT524378OtherCONNECTICARE
CTZS218OtherOXFORD
CT010024378CT01OtherANTHEM BLUE CROSS