Healthcare Provider Details

I. General information

NPI: 1700703931
Provider Name (Legal Business Name): COREY ALLEN MARTZALL AGNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 PLEASANT ST
BERLIN NH
03570-2006
US

IV. Provider business mailing address

133 PLEASANT ST
BERLIN NH
03570-2006
US

V. Phone/Fax

Practice location:
  • Phone: 603-752-2040
  • Fax:
Mailing address:
  • Phone: 603-752-2040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number077244-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: