Provider Demographics
NPI:1750314688
Name:MARTINI, MARY C (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:C
Last Name:MARTINI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:490 E NORTH AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-4740
Mailing Address - Country:US
Mailing Address - Phone:412-359-3376
Mailing Address - Fax:412-359-5094
Practice Address - Street 1:490 E NORTH AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4740
Practice Address - Country:US
Practice Address - Phone:412-359-3376
Practice Address - Fax:412-359-5094
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD036219207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011199060003Medicaid
PA001119906Medicaid
PA11046061OtherCAQH
PA033636Medicare PIN
PA0011199060003Medicaid