Provider Demographics
NPI:1538111281
Name:MARTELLO, ALFRED J (MD)
Entity Type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:J
Last Name:MARTELLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 W MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-2218
Mailing Address - Country:US
Mailing Address - Phone:517-787-6440
Mailing Address - Fax:
Practice Address - Street 1:4665 DOUGLAS CIR NW
Practice Address - Street 2:SUITE 101
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-3673
Practice Address - Country:US
Practice Address - Phone:330-489-1698
Practice Address - Fax:330-489-1325
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35041878207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0155997Medicaid
050036546OtherMEDICARE RAILROAD
000000135917OtherANTHEM
G04681Medicare UPIN
OH0155997Medicaid
OH0783914Medicare PIN