Provider Demographics
NPI:1912001397
Name:MICHAEL R MARTZ
Entity Type:Organization
Organization Name:MICHAEL R MARTZ
Other - Org Name:ALBTUCK FAMILY MEDICAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:P
Authorized Official - Last Name:MCCLUNG-MARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-453-3013
Mailing Address - Street 1:4039 CARATOKE HWY
Mailing Address - Street 2:
Mailing Address - City:BARCO
Mailing Address - State:NC
Mailing Address - Zip Code:27917
Mailing Address - Country:US
Mailing Address - Phone:252-453-3013
Mailing Address - Fax:252-453-4180
Practice Address - Street 1:4039 CARATOKE HWY
Practice Address - Street 2:
Practice Address - City:BARCO
Practice Address - State:NC
Practice Address - Zip Code:27917
Practice Address - Country:US
Practice Address - Phone:252-453-3013
Practice Address - Fax:252-453-4180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2013-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890102JMedicaid
NC890102JMedicaid
NC1264Medicare ID - Type Unspecified