Provider Demographics
NPI:1154332062
Name:MARTINEZ, CARLOS EZEQUIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:EZEQUIEL
Last Name:MARTINEZ
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 1:277 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-4060
Mailing Address - Country:US
Mailing Address - Phone:607-797-4351
Mailing Address - Fax:
Practice Address - Street 1:277 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905-4060
Practice Address - Country:US
Practice Address - Phone:607-651-5219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD455301207R00000X
FLME 94418207R00000X
NY234979207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02662875Medicaid
NY02662875Medicaid