Provider Demographics
NPI:1841536075
Name:MARTIN A. O'TOOLE, MD, FACS, A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:MARTIN A. O'TOOLE, MD, FACS, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:O'TOOLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-449-8910
Mailing Address - Street 1:542 S FAIR OAKS AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-2606
Mailing Address - Country:US
Mailing Address - Phone:626-449-8910
Mailing Address - Fax:
Practice Address - Street 1:542 S FAIR OAKS AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2606
Practice Address - Country:US
Practice Address - Phone:626-449-8910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-16
Last Update Date:2012-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG67312208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G673120Medicaid
CA00G673120Medicaid
CAG30064Medicare UPIN