MEDICARE: DR. GREGG GABRIEL MARTYAK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207XS0106X	Orthopaedic Hand Surgery Physician	MD425153	PA

General Provider Information

NPI Number	:	1558565044
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGG GABRIEL MARTYAK M.D.

Provider Business Mailing Address
First Line	:	2925 PROFESSIONAL PL
Second Line	:	STE 201
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80904-8133
Country	:	US
Telephone Number	:	719-260-4767
Fax Number	:	719-260-4765

Provider Business Practice Location Address
First Line	:	1015 WALNUT ST STE 801
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-5005
Country	:	US
Telephone Number	:	215-955-1500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2007
Last Update Date	:	05/17/2017

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