Provider Demographics
NPI:1255654190
Name:MARTIGNONI, CHARLES VIRGIL III
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:VIRGIL
Last Name:MARTIGNONI
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3410 GALT OCEAN DR
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-7044
Mailing Address - Country:US
Mailing Address - Phone:954-294-4554
Mailing Address - Fax:
Practice Address - Street 1:3410 GALT OCEAN DR
Practice Address - Street 2:PH2
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-7044
Practice Address - Country:US
Practice Address - Phone:954-294-4554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-06
Last Update Date:2010-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies