Healthcare Provider Details

I. General information

NPI: 1639152846
Provider Name (Legal Business Name): RICHARD ANTHONY MARTINELLO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 08/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 YORK ST HB-527
NEW HAVEN CT
06510-3220
US

IV. Provider business mailing address

20 YORK ST HB-527
NEW HAVEN CT
06510-3220
US

V. Phone/Fax

Practice location:
  • Phone: 203-688-4634
  • Fax: 203-688-2823
Mailing address:
  • Phone: 203-688-4634
  • Fax: 203-688-2823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number038728
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number038728
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: