Provider Demographics
NPI:1154364867
Name:MARTIMBEAU GYNECOLOGIC ONCOLOGY PA
Entity type:Organization
Organization Name:MARTIMBEAU GYNECOLOGIC ONCOLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PIERRE
Authorized Official - Middle Name:W
Authorized Official - Last Name:MARTIMBEAU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-334-8644
Mailing Address - Street 1:330 BILLINGSLEY RD
Mailing Address - Street 2:STE 202
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211
Mailing Address - Country:US
Mailing Address - Phone:704-334-8644
Mailing Address - Fax:704-358-1466
Practice Address - Street 1:330 BILLINGSLEY RD
Practice Address - Street 2:STE 202
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211
Practice Address - Country:US
Practice Address - Phone:704-334-8644
Practice Address - Fax:704-358-1466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24267207VG0400X, 207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
Not Answered207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8954121Medicaid
NC02093OtherBLUE CROSS
NC8902093Medicaid
NC02093OtherBLUE CROSS
NC8954121Medicaid