MEDICARE: GREGORY M MARTINO PHD

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	103T00000X	Psychologist	PS008503L	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	021494	OTHER		MEDICARE IDENTIFICATION NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	P00067507	OTHER	RAILROAD
2	340518	OTHER	HIGHMARK
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740281138
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY M MARTINO PHD

Provider Business Mailing Address
First Line	:	214 MC CRACKEN RUN ROAD
Second Line	:
City	:	DUBOIS
State	:	PA
Zip	:	15801-3634
Country	:	US
Telephone Number	:	814-371-2577
Fax Number	:	814-371-2577

Provider Business Practice Location Address
First Line	:	214 MC CRACKEN RUN ROAD
Second Line	:
City	:	DUBOIS
State	:	PA
Zip	:	15801-3634
Country	:	US
Telephone Number	:	814-371-2577
Fax Number	:	814-371-2577

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

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	03/27/2014

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Directions to “ GREGORY M MARTINO PHD” Practice Location

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