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General NPI Number Information
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NPI Number | 1154332062
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Entity Type | Individual
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Provider Name | CARLOS EZEQUIEL MARTINEZ M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/10/2006
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Last Update Date | 05/13/2020
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Provider Practice Location Address
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Address Line | 277 RIVERSIDE DR
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City | BINGHAMTON
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State | NY
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Zip | 13905-4060
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Country | US
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Telephone | 607-651-5219
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Fax |
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Provider Business Mailing Address
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Address Line | 277 RIVERSIDE DR
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City | BINGHAMTON
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State | NY
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Zip | 13905-4060
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Country | US
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Telephone | 607-797-4351
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD455301
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME 94418
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 234979
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License Number State | NY
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