Healthcare Provider Details

I. General information

NPI: 1972529907
Provider Name (Legal Business Name): CHRISTOPHER JOSEPH MARTINO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 03/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 MAPLE ST, STE 400
GILFORD NH
03249
US

IV. Provider business mailing address

14 MAPLE ST, STE 400
GILFORD NH
03249
US

V. Phone/Fax

Practice location:
  • Phone: 603-524-0700
  • Fax: 603-528-3521
Mailing address:
  • Phone: 603-524-0700
  • Fax: 603-528-3521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number7525
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: