Provider Demographics
NPI:1700147501
Name:MARTELL, DAVID W (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:W
Last Name:MARTELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 SW 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66606-1707
Mailing Address - Country:US
Mailing Address - Phone:785-354-8518
Mailing Address - Fax:785-354-1255
Practice Address - Street 1:4201 ANDERSON AVE STE B2
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66503-7603
Practice Address - Country:US
Practice Address - Phone:785-320-7774
Practice Address - Fax:785-320-7758
Is Sole Proprietor?:No
Enumeration Date:2012-06-07
Last Update Date:2023-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-41562207ND0101X, 207N00000X
NE1088207NS0135X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN