Healthcare Provider Details

I. General information

NPI: 1902760283
Provider Name (Legal Business Name): MR. JOHN ROBERT MARTIGNETTI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2225 PORTLAND ST
ST JOHNSBURY VT
05819-8635
US

IV. Provider business mailing address

2225 PORTLAND ST
ST JOHNSBURY VT
05819-8635
US

V. Phone/Fax

Practice location:
  • Phone: 802-748-3181
  • Fax: 802-748-0704
Mailing address:
  • Phone: 802-748-3181
  • Fax: 802-748-0704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberS94
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: