Provider Demographics
NPI:1508554312
Name:MARTINO, MARCO JOHN (LAC)
Entity Type:Individual
Prefix:MR
First Name:MARCO
Middle Name:JOHN
Last Name:MARTINO
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 86
Mailing Address - Street 2:
Mailing Address - City:EPSOM
Mailing Address - State:NH
Mailing Address - Zip Code:03234
Mailing Address - Country:US
Mailing Address - Phone:603-305-9398
Mailing Address - Fax:
Practice Address - Street 1:67 OAK RIDGE DR
Practice Address - Street 2:
Practice Address - City:EPSOM
Practice Address - State:NH
Practice Address - Zip Code:03234
Practice Address - Country:US
Practice Address - Phone:603-305-9398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-28
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH340171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist