Provider Demographics
NPI:1891356275
Name:MARTINO ROSALVA MD PA
Entity Type:Organization
Organization Name:MARTINO ROSALVA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARTINO
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSALVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:939-246-7890
Mailing Address - Street 1:10502 SE 29TH AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34480-7912
Mailing Address - Country:US
Mailing Address - Phone:352-245-6922
Mailing Address - Fax:352-245-6988
Practice Address - Street 1:18550 US HIGHWAY 441
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-6751
Practice Address - Country:US
Practice Address - Phone:352-245-6922
Practice Address - Fax:352-245-6988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-26
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty