Provider Demographics
NPI:1518043199
Name:MARTORANA, VINCENT J (DPM)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:J
Last Name:MARTORANA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 NORTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014
Mailing Address - Country:US
Mailing Address - Phone:410-803-0788
Mailing Address - Fax:410-803-1859
Practice Address - Street 1:9105 FRANKLIN SQUARE DRIVE
Practice Address - Street 2:SUITE 206
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237
Practice Address - Country:US
Practice Address - Phone:410-574-3900
Practice Address - Fax:410-574-0317
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00516213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD772968500Medicaid
MDH792OtherBLUE CROSS
MDE602OtherNATIONAL CAP BLUE
T59511Medicare UPIN
MDH792OtherBLUE CROSS
MD0734830006Medicare NSC
MD772968500Medicaid