Healthcare Provider Details

I. General information

NPI: 1710243506
Provider Name (Legal Business Name): JILL MARTINI D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2012
Last Update Date: 04/27/2023
Certification Date: 04/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 JOHN PAUL JONES CIR
PORTSMOUTH VA
23708-2111
US

IV. Provider business mailing address

620 JOHN PAUL JONES CIR
PORTSMOUTH VA
23708-2111
US

V. Phone/Fax

Practice location:
  • Phone: 757-953-7716
  • Fax: 757-953-0868
Mailing address:
  • Phone: 757-953-7550
  • Fax: 757-953-7560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0102203621
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: