Provider Demographics
NPI:1932182136
Name:MARTINSON, LARRY GENE (PA-C)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:GENE
Last Name:MARTINSON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:HERKIMER
Mailing Address - State:NY
Mailing Address - Zip Code:13350-2389
Mailing Address - Country:US
Mailing Address - Phone:315-574-2300
Mailing Address - Fax:315-574-2310
Practice Address - Street 1:201 E STATE ST
Practice Address - Street 2:
Practice Address - City:HERKIMER
Practice Address - State:NY
Practice Address - Zip Code:13350-2389
Practice Address - Country:US
Practice Address - Phone:315-574-2300
Practice Address - Fax:315-574-2310
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03798161Medicaid