Provider Demographics
NPI:1326015355
Name:MARTA, JOHN A (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:MARTA
Suffix:
Gender:M
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:PO BOX 820
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80901-0820
Mailing Address - Country:US
Mailing Address - Phone:719-448-0981
Mailing Address - Fax:719-448-0767
Practice Address - Street 1:2215 N CASCADE AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-6736
Practice Address - Country:US
Practice Address - Phone:719-776-5000
Practice Address - Fax:719-448-0767
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO17751207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO050042778OtherRAILROAD MEDICARE NUMBER
CO01177518Medicaid
COCL9718Medicare PIN
COD23339Medicare UPIN