Provider Demographics
NPI:1205883659
Name:CHATZINOFF, MARTIN (MD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:
Last Name:CHATZINOFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1095 RYDAL RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RYDAL
Mailing Address - State:PA
Mailing Address - Zip Code:19046-1711
Mailing Address - Country:US
Mailing Address - Phone:267-620-1100
Mailing Address - Fax:215-572-1279
Practice Address - Street 1:1095 RYDAL RD
Practice Address - Street 2:SUITE 100
Practice Address - City:RYDAL
Practice Address - State:PA
Practice Address - Zip Code:19046-1711
Practice Address - Country:US
Practice Address - Phone:267-620-1100
Practice Address - Fax:215-572-1279
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD030069E207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0081375000OtherKEYSTONE HEALTH PLAN EAST
PA1512826006OtherCIGNA
PA000122205OtherPERSONAL CHOICE
PAP386830OtherOXFORD
PA000122205OtherAMERIHEALTH
PA30006797OtherKEYSTONE MERCY
PA100006584OtherPALMETTO GBA
PA14617OtherHEALTH PARTNERS
PA231937219OtherFIRST HEALTH
PA231937219OtherMULTIPLAN
PW231937219OtherTRICARE
PA000122205OtherHIGHMARK BLUE SHIELD
PA0012281970004Medicaid
PA231937219OtherDEVON
PA4109831OtherAETNA
PA231937219OtherMULTIPLAN