Provider Demographics
NPI:1467557918
Name:SCZESNY-ALESHNICK, MARTINA (MD)
Entity type:Individual
Prefix:
First Name:MARTINA
Middle Name:
Last Name:SCZESNY-ALESHNICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARTINA
Other - Middle Name:
Other - Last Name:SCZESNY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:50 STANIFORD ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2517
Mailing Address - Country:US
Mailing Address - Phone:617-726-4626
Mailing Address - Fax:
Practice Address - Street 1:50 STANIFORD ST STE 1
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2517
Practice Address - Country:US
Practice Address - Phone:617-726-4626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0009544207Q00000X
WAMD61376486207Q00000X
MA276525207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH0106055YPVT01OtherBLUE SHEILD
NH30010878Medicaid
VTOVN1625Medicaid
VTSCZE00029671OtherBLUE SHEILD
VT8000693Medicaid
VT08P028OtherMVP
VT080156272Medicare ID - Type UnspecifiedRR MEDICARE
NH30010878Medicaid
VTVN1625Medicare ID - Type Unspecified