Healthcare Provider Details

I. General information

NPI: 1861726234
Provider Name (Legal Business Name): AILEEN MARIA MARTY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2009
Last Update Date: 05/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

885 SW 109 AVE SUITE 131
MIAMI FL
33199-2516
US

IV. Provider business mailing address

1509 NE 12TH PL
MIAMI BEACH FL
33139-1113
US

V. Phone/Fax

Practice location:
  • Phone: 305-348-3627
  • Fax: 305-348-4261
Mailing address:
  • Phone: 305-348-0377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberME-0047759
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberME-0047759
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: