Provider Demographics
NPI:1558400648
Name:MARTIROS, MARY (MED)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:
Last Name:MARTIROS
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 NEW BRAINTREE RD
Mailing Address - Street 2:
Mailing Address - City:OAKHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01068
Mailing Address - Country:US
Mailing Address - Phone:508-882-5504
Mailing Address - Fax:
Practice Address - Street 1:237 MILLBURY ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01610
Practice Address - Country:US
Practice Address - Phone:508-755-1228
Practice Address - Fax:508-797-3477
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator