Provider Demographics
NPI:1639381908
Name:MARTYAK, STEPHANIE M (DO)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:M
Last Name:MARTYAK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2 CHOATE LN
Mailing Address - Street 2:APT 106
Mailing Address - City:HALLOWELL
Mailing Address - State:ME
Mailing Address - Zip Code:04347-1722
Mailing Address - Country:US
Mailing Address - Phone:207-621-2444
Mailing Address - Fax:
Practice Address - Street 1:2 CHOATE LN
Practice Address - Street 2:#106
Practice Address - City:HALLOWELL
Practice Address - State:ME
Practice Address - Zip Code:04347-1722
Practice Address - Country:US
Practice Address - Phone:207-621-2444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2014-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101017070207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine