Provider Demographics
NPI:1235170572
Name:MARTINI, DAVID V (MD, PA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:V
Last Name:MARTINI
Suffix:
Gender:M
Credentials:MD, PA
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 8571
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17604-8571
Mailing Address - Country:US
Mailing Address - Phone:410-398-3445
Mailing Address - Fax:410-620-1538
Practice Address - Street 1:312 WESTSIDE DR
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-3530
Practice Address - Country:US
Practice Address - Phone:912-384-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0006640207Y00000X, 2086S0122X
MDD0059096207Y00000X, 2086S0122X
GA80480207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1235170572OtherINDIVIDUAL MEDICAID ID
GA80480OtherMEDICAL LICENSE
MD405979400OtherGROUP MEDICAID ID
DE1508811928OtherGROUP MEDICAID ID
DE248474YJQXOtherINDIVIDUAL MEDICARE PTAN
MD500MOtherGROUP MEDICARE PTAN
MD500M759FOtherINDIVIDUAL MEDICARE PTAN
MD512502200OtherINDIVIDUAL MEDICAID ID
MDP00209459OtherMEDICARE RAILROAD
DE248471OtherGROUP MEDICARE PTAN