Provider Demographics
NPI:1306727821
Name:MARTIN'S TELEMEDICINE AND MENTAL HEALTH PC
Entity type:Organization
Organization Name:MARTIN'S TELEMEDICINE AND MENTAL HEALTH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:PETREL
Authorized Official - Middle Name:D
Authorized Official - Last Name:MARTIN-HALL
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:443-800-6481
Mailing Address - Street 1:15 LUFFING CT
Mailing Address - Street 2:
Mailing Address - City:ESSEX
Mailing Address - State:MD
Mailing Address - Zip Code:21221-2934
Mailing Address - Country:US
Mailing Address - Phone:443-800-6481
Mailing Address - Fax:
Practice Address - Street 1:15 LUFFING CT
Practice Address - Street 2:
Practice Address - City:ESSEX
Practice Address - State:MD
Practice Address - Zip Code:21221-2934
Practice Address - Country:US
Practice Address - Phone:443-800-6481
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-10
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & AgingGroup - Multi-Specialty
No103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty