1740263300 NPI number — PATRICIA A MARTZ M.D., FACS

Table of content: PATRICIA A MARTZ M.D., FACS (NPI 1740263300)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740263300 NPI number — PATRICIA A MARTZ M.D., FACS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTZ
Provider First Name:
PATRICIA
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D., FACS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MARTZ
Provider Other First Name:
PATRICIA
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1740263300
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/03/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 593
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAPE MAY COURT HOUSE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08210-0593
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-463-2755
Provider Business Mailing Address Fax Number:
609-463-2757

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
217 N MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
CAPE MAY COURT HOUSE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08210-2165
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-463-1488
Provider Business Practice Location Address Fax Number:
609-463-4881
Provider Enumeration Date:
11/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  MD059494L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X , with the licence number: 25MA09670700 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8285403 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001757688004 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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