Provider Demographics
NPI:1437148715
Name:DAVID J MARTINI MD
Entity Type:Organization
Organization Name:DAVID J MARTINI MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:MARTINI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-744-2182
Mailing Address - Street 1:460 TOTTEN POND RD
Mailing Address - Street 2:C/O MZI
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451-1991
Mailing Address - Country:US
Mailing Address - Phone:781-890-9933
Mailing Address - Fax:781-890-9950
Practice Address - Street 1:79 HIGHLAND AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-2711
Practice Address - Country:US
Practice Address - Phone:978-744-2182
Practice Address - Fax:978-741-7667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA39883208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2058162Medicaid
MAM09597OtherBCBS
MA705904OtherTUFTS
MA8913OtherHPHC
MA2058162Medicaid