Provider Demographics
NPI:1144220567
Name:MARTINO, JAMES V (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:V
Last Name:MARTINO
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 1:149 N VINE ST
Mailing Address - Street 2:
Mailing Address - City:HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18201-5852
Mailing Address - Country:US
Mailing Address - Phone:570-459-0414
Mailing Address - Fax:570-978-3465
Practice Address - Street 1:149 N VINE ST
Practice Address - Street 2:
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18201-5852
Practice Address - Country:US
Practice Address - Phone:570-459-0414
Practice Address - Fax:570-978-3465
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD048040L207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00152492600002Medicaid
PA693118Medicare PIN
PA00152492600002Medicaid