Healthcare Provider Details

I. General information

NPI: 1982601407
Provider Name (Legal Business Name): STEPHEN PAUL MARTELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 11/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 E MAIN ST
LEOLA PA
17540-1964
US

IV. Provider business mailing address

146 E MAIN ST
LEOLA PA
17540-1964
US

V. Phone/Fax

Practice location:
  • Phone: 717-656-2141
  • Fax: 717-656-4986
Mailing address:
  • Phone: 717-656-2141
  • Fax: 717-656-4986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD016596E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: