Healthcare Provider Details

I. General information

NPI: 1841399599
Provider Name (Legal Business Name): LUIS F. MARTI-CALZAMILIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: LUIS F. MARTI M.D.

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 PATEWOOD DR SUITE A200
GREENVILLE SC
29615-3593
US

IV. Provider business mailing address

255 ENTERPRISE BLVD SUITE 102
GREENVILLE SC
29615-6300
US

V. Phone/Fax

Practice location:
  • Phone: 864-454-5115
  • Fax:
Mailing address:
  • Phone: 864-454-2413
  • Fax: 864-454-1144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License NumberTL29377
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: