Provider Demographics
NPI:1669465076
Name:MARTELLO, MARY BERNADETTE (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:BERNADETTE
Last Name:MARTELLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:2623 WHITEFORD RD
Mailing Address - Street 2:
Mailing Address - City:WHITEFORD
Mailing Address - State:MD
Mailing Address - Zip Code:21160-1103
Mailing Address - Country:US
Mailing Address - Phone:410-452-5515
Mailing Address - Fax:410-452-8030
Practice Address - Street 1:2623 WHITEFORD RD
Practice Address - Street 2:
Practice Address - City:WHITEFORD
Practice Address - State:MD
Practice Address - Zip Code:21160-1103
Practice Address - Country:US
Practice Address - Phone:410-452-5515
Practice Address - Fax:410-452-8030
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0056091207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDH26543Medicare UPIN