1891735395 NPI number — JOHN MARTY D.O.

Table of content: JOHN MARTY D.O. (NPI 1891735395)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891735395 NPI number — JOHN MARTY D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTY
Provider First Name:
JOHN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891735395
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 845614
Provider Second Line Business Mailing Address:
CHESHIRE ANESTHESIA
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02284-5614
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-720-1664
Provider Business Mailing Address Fax Number:
207-753-2020

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
580 COURT ST
Provider Second Line Business Practice Location Address:
ANESTHESIA DEPT
Provider Business Practice Location Address City Name:
KEENE
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03431-1715
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-354-5454
Provider Business Practice Location Address Fax Number:
603-354-5428
Provider Enumeration Date:
06/07/2006

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: 207L00000X , with the licence number:  8716 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 050031208 . This is a "RAILRAOD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 80002240 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".




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