Provider Demographics
NPI:1467423848
Name:OSTRO, MARTIN GEORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:GEORGE
Last Name:OSTRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1101 BEACON ST
Mailing Address - Street 2:SUITE 7 EAST
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-5540
Mailing Address - Country:US
Mailing Address - Phone:617-734-2202
Mailing Address - Fax:617-734-2408
Practice Address - Street 1:1101 BEACON ST
Practice Address - Street 2:SUITE 7 EAST
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-5540
Practice Address - Country:US
Practice Address - Phone:617-734-2202
Practice Address - Fax:617-734-2408
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA42186207K00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3015882Medicaid
MA3015882Medicaid
MAB47171Medicare PIN