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NPI Code Detail

MEDICARE: CAROLYN BURKE MARTINDALE APRN

MEDICARE: CAROLYN BURKE MARTINDALE APRN
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
1363L00000XNurse Practitioner002320CT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1457347551
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAROLYN BURKE MARTINDALE APRN
Provider Business Mailing Address
First Line : 80 SEYMOUR ST
Second Line :
City : HARTFORD
State : CT
Zip : 06102-8000
Country : US
Telephone Number : 860-545-7500
Fax Number :
Provider Business Practice Location Address
First Line : 80 SEYMOUR ST
Second Line :
City : HARTFORD
State : CT
Zip : 06106-3315
Country : US
Telephone Number : 860-545-7500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/23/2005
Last Update Date : 06/05/2018

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