Provider Demographics
NPI:1821125899
Name:DEMARTINO, WENDY ANNE (MD)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:ANNE
Last Name:DEMARTINO
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 1:9 AMBERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:NH
Mailing Address - Zip Code:03833-4723
Mailing Address - Country:US
Mailing Address - Phone:518-577-9669
Mailing Address - Fax:603-580-7006
Practice Address - Street 1:17 BELMONT AVE STE 1
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-3498
Practice Address - Country:US
Practice Address - Phone:180-225-7820
Practice Address - Fax:802-257-8834
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD23528207PE0004X
VT042.0015002207P00000X
PAMD469629207P00000X
NHNH16303207P00000X
NY241771207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3090003Medicaid
VT6705352Medicaid