Provider Demographics
NPI:1518952886
Name:MARTINI, DANA LYNN (DO)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:LYNN
Last Name:MARTINI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 601372
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1372
Mailing Address - Country:US
Mailing Address - Phone:704-355-9047
Mailing Address - Fax:704-355-9458
Practice Address - Street 1:1100 BLYTHE BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203
Practice Address - Country:US
Practice Address - Phone:704-355-9047
Practice Address - Fax:704-355-9458
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS012401208100000X
NC2012-01403208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1518952886Medicaid
SCNC1706Medicaid
NC5921726Medicaid
NCNC8970AMedicare PIN
NC1518952886Medicaid
NC5921726Medicaid