Provider Demographics
NPI:1639152846
Name:MARTINELLO, RICHARD ANTHONY (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:ANTHONY
Last Name:MARTINELLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:20 YORK ST
Mailing Address - Street 2:HB-527
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-3220
Mailing Address - Country:US
Mailing Address - Phone:203-688-4634
Mailing Address - Fax:203-688-2823
Practice Address - Street 1:20 YORK ST
Practice Address - Street 2:HB-527
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3220
Practice Address - Country:US
Practice Address - Phone:203-688-4634
Practice Address - Fax:203-688-2823
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2015-08-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT0387282080P0208X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001387283Medicaid
CT001387283Medicaid
CT001387283Medicaid