Provider Demographics
NPI:1174515142
Name:MAINELLO, MARTHA ANNE (RPA-C)
Entity type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:ANNE
Last Name:MAINELLO
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:ANNE
Other - Last Name:MINEHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 14890
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12212-4890
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2 PALISADES DR
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-1438
Practice Address - Country:US
Practice Address - Phone:518-458-2000
Practice Address - Fax:518-458-1524
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2025-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003594363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01276553Medicaid
VT9001009Medicaid
NYJ400372025Medicare PIN
NYS66556Medicare UPIN
NY01276553Medicaid