Healthcare Provider Details

I. General information

NPI: 1205156676
Provider Name (Legal Business Name): CHRISTINE D MARTINO D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2010
Last Update Date: 08/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10800 KNIGHTS RD
PHILADELPHIA PA
19114-4200
US

IV. Provider business mailing address

P. O. BOX 8500-6335
PHILADELPHIA PA
19178-6335
US

V. Phone/Fax

Practice location:
  • Phone: 215-612-4000
  • Fax:
Mailing address:
  • Phone: 215-638-0666
  • Fax: 215-638-3320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberOT013390
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOT013390
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: