Provider Demographics
NPI:1417168220
Name:EDGAR A MARTORELL MD LLC
Entity Type:Organization
Organization Name:EDGAR A MARTORELL MD LLC
Other - Org Name:ARC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDGAR
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARTORELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-313-0044
Mailing Address - Street 1:6735 CONROY WINDERMERE RD STE320
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-6879
Mailing Address - Country:US
Mailing Address - Phone:407-313-0044
Mailing Address - Fax:407-313-0810
Practice Address - Street 1:6735 CONROY WINDERMERE RD
Practice Address - Street 2:STE 320
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-3283
Practice Address - Country:US
Practice Address - Phone:407-313-0044
Practice Address - Fax:407-313-0810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85698207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1336115773OtherNPI-PERSONAL
FL1417168220OtherNPI-GROUP