Provider Demographics
NPI:1841238011
Name:MARTINO, ANTHONY M (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:M
Last Name:MARTINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 40480
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36640-0480
Mailing Address - Country:US
Mailing Address - Phone:251-660-5108
Mailing Address - Fax:251-665-8299
Practice Address - Street 1:1601 CENTER ST
Practice Address - Street 2:STE 2S
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36604-1512
Practice Address - Country:US
Practice Address - Phone:251-660-5108
Practice Address - Fax:251-665-8299
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL26336207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51526881OtherBLUE CROSS
FL272176700Medicaid
AL009984065Medicaid
LA1165026Medicaid
MS05432819Medicaid
AL06-00011OtherUNITED HEALTH CARE
MS05432819Medicaid