Provider Demographics
NPI:1073543195
Name:MOTEL, MARTA (DO)
Entity Type:Individual
Prefix:
First Name:MARTA
Middle Name:
Last Name:MOTEL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 IRON BRIDGE DR STE 150
Mailing Address - Street 2:
Mailing Address - City:COLLEGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19426-2042
Mailing Address - Country:US
Mailing Address - Phone:484-622-6320
Mailing Address - Fax:484-622-6337
Practice Address - Street 1:17 IRON BRIDGE DR STE 150
Practice Address - Street 2:
Practice Address - City:COLLEGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19426-2042
Practice Address - Country:US
Practice Address - Phone:484-622-6320
Practice Address - Fax:484-622-6337
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006891L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012513000006Medicaid
PA681133Medicare ID - Type Unspecified
PAE93773Medicare UPIN