Healthcare Provider Details

I. General information

NPI: 1275028706
Provider Name (Legal Business Name): GABRIEL A MARTINEZ MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2018
Last Update Date: 06/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9106 PHILADELPHIA RD STE 306
BALTIMORE MD
21237-4343
US

IV. Provider business mailing address

9106 PHILADELPHIA RD STE 306
BALTIMORE MD
21237-4343
US

V. Phone/Fax

Practice location:
  • Phone: 410-687-2656
  • Fax: 410-687-3805
Mailing address:
  • Phone: 410-687-2656
  • Fax: 410-687-3805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: GABRIEL MARTINEZ
Title or Position: OWNER
Credential:
Phone: 410-687-2656