Provider Demographics
NPI:1093110207
Name:MARTINA, GERARD
Entity Type:Individual
Prefix:
First Name:GERARD
Middle Name:
Last Name:MARTINA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9917 LARGO CT
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-8379
Mailing Address - Country:US
Mailing Address - Phone:513-545-9589
Mailing Address - Fax:
Practice Address - Street 1:9917 LARGO CT
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-8379
Practice Address - Country:US
Practice Address - Phone:513-545-9589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-30
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider