Provider Demographics
NPI:1508811928
Name:DAVID V. MARTINI, M.D. P.A.
Entity Type:Organization
Organization Name:DAVID V. MARTINI, M.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:V
Authorized Official - Last Name:MARTINI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-398-3445
Mailing Address - Street 1:PO BOX 8571
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17604-8571
Mailing Address - Country:US
Mailing Address - Phone:410-398-3445
Mailing Address - Fax:
Practice Address - Street 1:330 E PULASKI HWY
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-6435
Practice Address - Country:US
Practice Address - Phone:410-398-3445
Practice Address - Fax:410-620-1538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1235170572OtherINDIVIDUAL MEDICAID ID
MD500MOtherGROUP MEDICARE PTAN
MD405979400OtherGROUP MEDICAID ID
MD500M759FOtherINDIVIDUAL MEDICARE PTAN
MDP00209459OtherMEDICARE RAILROAD
DE248471OtherGROUP MEDICARE PTAN
MD512502200OtherINDIVIDUAL MEDICAID ID
DE1508811928OtherGROUP MEDICAID ID
DE248474YJQXOtherINDIVIDUAL MEDICARE PTAN