Healthcare Provider Details

I. General information

NPI: 1700147501
Provider Name (Legal Business Name): DAVID W MARTELL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2012
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 ANDERSON AVE STE B2
MANHATTAN KS
66503-7603
US

IV. Provider business mailing address

2200 SW 6TH AVE
TOPEKA KS
66606-1707
US

V. Phone/Fax

Practice location:
  • Phone: 785-320-7774
  • Fax: 785-320-7758
Mailing address:
  • Phone: 785-354-8518
  • Fax: 785-354-1255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number05-41562
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number1088
License Number StateNE
# 3
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number05-41562
License Number StateKS

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: