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General NPI Number Information
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NPI Number | 1104237510
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Entity Type | Individual
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Provider Name | PEDRO ENRIQUE MARTINEZ M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/20/2014
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Last Update Date | 05/20/2014
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Provider Practice Location Address
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Address Line | 9000 ROCKVILLE PIKE BUILDING 10 CRC, ROOM 2-5330
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City | BETHESDA
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State | MD
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Zip | 20892-0001
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Country | US
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Telephone | 301-402-0615
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Fax | 301-480-4597
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Provider Business Mailing Address
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Address Line | 8000 BLAIR MILL DR. APT 101
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City | SILVER SPRING
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State | MD
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Zip | 20910
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Country | US
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Telephone | 301-402-0615
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 4612A
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License Number State | WY
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