Provider Demographics
NPI:1629398151
Name:MARTINS, SUZANNE J (LMT)
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:J
Last Name:MARTINS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 OAK RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-6315
Mailing Address - Country:US
Mailing Address - Phone:203-482-3130
Mailing Address - Fax:203-778-4560
Practice Address - Street 1:40 LAKE AVENUE EXT
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06811-5283
Practice Address - Country:US
Practice Address - Phone:203-482-3130
Practice Address - Fax:203-778-4560
Is Sole Proprietor?:No
Enumeration Date:2010-06-07
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4288174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist