Provider Demographics
NPI:1952349797
Name:MARTINA, CARMEN A (DPM)
Entity Type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:A
Last Name:MARTINA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:HADDON HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08035-1835
Mailing Address - Country:US
Mailing Address - Phone:856-546-6459
Mailing Address - Fax:856-546-7636
Practice Address - Street 1:319 10TH AVE
Practice Address - Street 2:
Practice Address - City:HADDON HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:08035-1835
Practice Address - Country:US
Practice Address - Phone:856-546-6459
Practice Address - Fax:856-546-7636
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00092800213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4858409Medicaid
NJT44620Medicare UPIN
NJ049055Medicare ID - Type UnspecifiedMEDICARE I.D. NUMBER