MEDICARE: ROBERT A MARTELLO DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	OS7122	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	080101521	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	57335	OTHER	FL	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205879236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT A MARTELLO DO

Provider Business Mailing Address
First Line	:	3619 LAKE CENTER DR
Second Line	:
City	:	MOUNT DORA
State	:	FL
Zip	:	32757-2364
Country	:	US
Telephone Number	:	352-383-8222
Fax Number	:

Provider Business Practice Location Address
First Line	:	3619 LAKE CENTER DR
Second Line	:
City	:	MOUNT DORA
State	:	FL
Zip	:	32757-2364
Country	:	US
Telephone Number	:	352-383-8222
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	11/04/2024

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Directions to “ ROBERT A MARTELLO DO” Practice Location

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