Provider Demographics
NPI:1225018690
Name:DEMARTINO, JULIANNE
Entity Type:Individual
Prefix:
First Name:JULIANNE
Middle Name:
Last Name:DEMARTINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8594 RAINTREE RUN
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514-2987
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:350 SHARON NEW CASTLE RD
Practice Address - Street 2:
Practice Address - City:FARRELL
Practice Address - State:PA
Practice Address - Zip Code:16121-1576
Practice Address - Country:US
Practice Address - Phone:724-347-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD459654174400000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2206875Medicaid
OH2206875Medicaid
OH2206875Medicaid