Provider Demographics
NPI:1972589125
Name:MARTELO, CHARLOTTE CAROLINE FRANCES (CRNA)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:CAROLINE FRANCES
Last Name:MARTELO
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 KENSICO DR
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-1009
Mailing Address - Country:US
Mailing Address - Phone:800-362-6220
Mailing Address - Fax:914-666-6777
Practice Address - Street 1:43 KENSICO DR
Practice Address - Street 2:2ND FLOOR
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-1009
Practice Address - Country:US
Practice Address - Phone:800-362-6220
Practice Address - Fax:914-666-6777
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY567245367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0421XIMedicare ID - Type UnspecifiedGHI MEDICARE
NY0966T1Medicare ID - Type UnspecifiedEMPIRE MEDICARE