Provider Demographics
NPI:1417946799
Name:MARTINI, DAVID J (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:MARTINI
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:55 FRUIT ST
Mailing Address - Street 2:YAWKEY BUILDING, 7TH FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2621
Mailing Address - Country:US
Mailing Address - Phone:617-726-8290
Mailing Address - Fax:617-724-3895
Practice Address - Street 1:104 ENDICOTT ST
Practice Address - Street 2:SUITE 200
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-3623
Practice Address - Country:US
Practice Address - Phone:978-882-6899
Practice Address - Fax:978-882-6890
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2012-08-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA39883208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA8913OtherHPHC
MA2058162Medicaid
MA705904OtherTUFTS
MAM09597OtherBCBS
B98701Medicare UPIN
M09597Medicare ID - Type Unspecified