Provider Demographics
NPI:1235410846
Name:MARTINO, DAVID NICHOLAS (NP)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:NICHOLAS
Last Name:MARTINO
Suffix:
Gender:M
Credentials:NP
Other - Prefix:MS
Other - First Name:AMANDA
Other - Middle Name:ELISABETH
Other - Last Name:MARTINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1 LAUREL PATH
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:MA
Mailing Address - Zip Code:02056-1062
Mailing Address - Country:US
Mailing Address - Phone:617-945-6931
Mailing Address - Fax:
Practice Address - Street 1:1600 PROVIDENCE HWY STE 167
Practice Address - Street 2:
Practice Address - City:WALPOLE
Practice Address - State:MA
Practice Address - Zip Code:02081-2553
Practice Address - Country:US
Practice Address - Phone:508-660-7949
Practice Address - Fax:508-660-7943
Is Sole Proprietor?:No
Enumeration Date:2011-09-09
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2268151363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health