Provider Demographics
NPI:1780638445
Name:MARTINEZ, MICHAEL F (MD, FACS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:F
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:MD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:PALMERTON
Mailing Address - State:PA
Mailing Address - Zip Code:18071-1812
Mailing Address - Country:US
Mailing Address - Phone:610-826-4595
Mailing Address - Fax:610-826-4399
Practice Address - Street 1:255 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:PALMERTON
Practice Address - State:PA
Practice Address - Zip Code:18071-1812
Practice Address - Country:US
Practice Address - Phone:610-826-4595
Practice Address - Fax:610-826-4399
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD063535L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017949770002Medicaid
PACH1856OtherRAILROAD MEDICARE
PA001794977Medicaid
PA037564Medicare ID - Type Unspecified
PACH1856OtherRAILROAD MEDICARE
PA037564NSYMedicare Oscar/Certification