Healthcare Provider Details

I. General information

NPI: 1700503869
Provider Name (Legal Business Name): PAUL MARTINETTI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2022
Last Update Date: 10/20/2022
Certification Date: 10/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98 DISPATCH DR
WASHINGTON CROSSING PA
18977-1168
US

IV. Provider business mailing address

98 DISPATCH DR
WASHINGTON CROSSING PA
18977-1168
US

V. Phone/Fax

Practice location:
  • Phone: 215-359-8047
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: