Provider Demographics
NPI:1821029216
Name:MARTEN, BRIAN RODNEY (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:RODNEY
Last Name:MARTEN
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 1:3400 DATA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:916-816-1846
Mailing Address - Fax:
Practice Address - Street 1:6555 COYLE AVE
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-0302
Practice Address - Country:US
Practice Address - Phone:916-536-3666
Practice Address - Fax:916-536-3515
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG867582085R0202X, 2085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G867580OtherMEDI-CAL
P00003063OtherRAILROAD MEDICARE
CA00G867580OtherMEDI-CAL
CA680220314OtherFEDERAL TIN
CA00G867580OtherMEDI-CAL
00G867580Medicare ID - Type Unspecified