Healthcare Provider Details

I. General information

NPI: 1518952886
Provider Name (Legal Business Name): DANA LYNN MARTINI DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 11/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 BLYTHE BLVD
CHARLOTTE NC
28203
US

IV. Provider business mailing address

PO BOX 601372
CHARLOTTE NC
28260-1372
US

V. Phone/Fax

Practice location:
  • Phone: 704-355-9047
  • Fax: 704-355-9458
Mailing address:
  • Phone: 704-355-9047
  • Fax: 704-355-9458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberOS012401
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number2012-01403
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: