Provider Demographics
NPI:1295760742
Name:MARTONE, JEFFREY D (DPM)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:D
Last Name:MARTONE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108-3102
Mailing Address - Country:US
Mailing Address - Phone:860-289-4500
Mailing Address - Fax:860-528-5298
Practice Address - Street 1:11 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06108-3102
Practice Address - Country:US
Practice Address - Phone:860-289-4500
Practice Address - Fax:860-528-5298
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000621213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTU48222Medicare UPIN
CT4583240001Medicare NSC