Healthcare Provider Details

I. General information

NPI: 1447221510
Provider Name (Legal Business Name): MARK G MARTENS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 02/13/2025
Certification Date: 10/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 NORTH ST STE 2
AUBURN NY
13021-1983
US

IV. Provider business mailing address

17 LANSING ST
AUBURN NY
13021-1983
US

V. Phone/Fax

Practice location:
  • Phone: 315-252-5028
  • Fax: 315-252-1587
Mailing address:
  • Phone: 315-255-7011
  • Fax: 315-255-7099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD464152
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number25MA08692100
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number320910
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: