Provider Demographics
NPI:1972519072
Name:MARTYNIK, MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:MARTYNIK
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 1:1034 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-2945
Mailing Address - Country:US
Mailing Address - Phone:814-373-2156
Mailing Address - Fax:814-373-2159
Practice Address - Street 1:765 LIBERTY ST STE 207
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-2568
Practice Address - Country:US
Practice Address - Phone:814-373-2156
Practice Address - Fax:814-373-2159
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY178238208800000X
PAMD033101E208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01915728Medicaid
NY248074OtherMVP HEALTHPLAN
10033939OtherCDPHP
NY01915728Medicaid
10033939OtherCDPHP