Provider Demographics
NPI:1083808711
Name:DECEMBRINO, MARTHA (RAC)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:DECEMBRINO
Suffix:
Gender:F
Credentials:RAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1235 PENN AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-2100
Mailing Address - Country:US
Mailing Address - Phone:610-374-2927
Mailing Address - Fax:610-374-2909
Practice Address - Street 1:1235 PENN AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-2100
Practice Address - Country:US
Practice Address - Phone:610-374-2927
Practice Address - Fax:610-374-2909
Is Sole Proprietor?:No
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAK000599171100000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine