Healthcare Provider Details

I. General information

NPI: 1346159811
Provider Name (Legal Business Name): ANTONIO MARTINEZ PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 WOODLAND ST
HARTFORD CT
06105-4318
US

IV. Provider business mailing address

63 WHITMORE ST APT 1W
HARTFORD CT
06114-1388
US

V. Phone/Fax

Practice location:
  • Phone: 860-228-9300
  • Fax: 860-228-4703
Mailing address:
  • Phone: 860-228-9300
  • Fax: 860-228-4703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberCT7777
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: