Healthcare Provider Details

I. General information

NPI: 1780809541
Provider Name (Legal Business Name): GABRIEL U MARTZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 02/20/2023
Certification Date: 02/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 SEYMOUR ST STE 815
HARTFORD CT
06106-5527
US

IV. Provider business mailing address

80 SEYMOUR ST JEFFERSON BUILDING, SUITE 607
HARTFORD CT
06102
US

V. Phone/Fax

Practice location:
  • Phone: 860-972-3600
  • Fax: 860-545-5003
Mailing address:
  • Phone: 860-972-0726
  • Fax: 860-545-1976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number47266
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number57152
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number47266
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number57152
License Number StateCT
# 5
Primary TaxonomyY
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License Number57152
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: