Provider Demographics
NPI:1366679581
Name:THOMAS JOSEPH MARTINELLI MD A PROFESSIONAL CORP
Entity Type:Organization
Organization Name:THOMAS JOSEPH MARTINELLI MD A PROFESSIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MARTINELLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-458-3563
Mailing Address - Street 1:1225 MARSHALL ST STE 7
Mailing Address - Street 2:
Mailing Address - City:CRESCENT CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95531-2281
Mailing Address - Country:US
Mailing Address - Phone:707-464-1989
Mailing Address - Fax:
Practice Address - Street 1:413 MILL BEACH RD
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:OR
Practice Address - Zip Code:97415-9690
Practice Address - Country:US
Practice Address - Phone:707-464-1989
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-15
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG042174207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty