Provider Demographics
NPI:1275526451
Name:MARTELLO, ANNE LOUISE (MD)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:LOUISE
Last Name:MARTELLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2623 WHITEFORD RD
Mailing Address - Street 2:
Mailing Address - City:WHITEFORD
Mailing Address - State:MD
Mailing Address - Zip Code:21160-1103
Mailing Address - Country:US
Mailing Address - Phone:410-452-5515
Mailing Address - Fax:410-452-8030
Practice Address - Street 1:2623 WHITEFORD RD
Practice Address - Street 2:
Practice Address - City:WHITEFORD
Practice Address - State:MD
Practice Address - Zip Code:21160-1103
Practice Address - Country:US
Practice Address - Phone:410-452-5515
Practice Address - Fax:410-452-8030
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0055832207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD607338-03 & 02OtherBLUE CROSS/BLUE SHIELD
MD130506900Medicaid
MD607338-03 & 02OtherBLUE CROSS/BLUE SHIELD
MDH23785Medicare UPIN
MDS08548QQMedicare PIN