Provider Demographics
NPI:1114919537
Name:MARTZ, MICHAEL R (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:R
Last Name:MARTZ
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:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:BARCO
Mailing Address - State:NC
Mailing Address - Zip Code:27917-0009
Mailing Address - Country:US
Mailing Address - Phone:252-453-3013
Mailing Address - Fax:252-453-4180
Practice Address - Street 1:4039 CARATOKE HWY
Practice Address - Street 2:
Practice Address - City:BARCO
Practice Address - State:NC
Practice Address - Zip Code:27917-9520
Practice Address - Country:US
Practice Address - Phone:252-453-3013
Practice Address - Fax:252-453-4180
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-22
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24787207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890102JMedicaid
NC8954545Medicaid
NC1264Medicare ID - Type Unspecified
NC208541CMedicare ID - Type Unspecified
NC8954545Medicaid