Provider Demographics
NPI:1639407679
Name:MARTINEZ, AUGUSTO RAFAEL (MD)
Entity Type:Individual
Prefix:
First Name:AUGUSTO
Middle Name:RAFAEL
Last Name:MARTINEZ
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 1:85 GRAND ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-1809
Mailing Address - Country:US
Mailing Address - Phone:305-297-9083
Mailing Address - Fax:
Practice Address - Street 1:465 S WASHINGTON ST UNIT 4
Practice Address - Street 2:
Practice Address - City:NORTH ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02760-2159
Practice Address - Country:US
Practice Address - Phone:781-562-0779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-03
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 53532208000000X
RIMD14410208000000X
MA70313208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics