Provider Demographics
NPI:1497071799
Name:MARTELLE TU, JENNIFER LYNN (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LYNN
Last Name:MARTELLE TU
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
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Mailing Address - Street 1:744 52ND ST FL 5
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-1810
Mailing Address - Country:US
Mailing Address - Phone:510-428-3590
Mailing Address - Fax:210-601-3974
Practice Address - Street 1:744 52ND ST FL 5
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-1810
Practice Address - Country:US
Practice Address - Phone:510-428-3590
Practice Address - Fax:210-601-3974
Is Sole Proprietor?:No
Enumeration Date:2010-04-12
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00815852084N0402X
VA01012602982084N0402X
CAA1192282084N0402X
DCMD0441422084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology