MEDICARE: ALLEN RICHARD MAERTIN 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	11019647A	IN
2	207Q00000X	Family Medicine Physician	02005469A	IN

General Provider Information

NPI Number	:	1790206977
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLEN RICHARD MAERTIN DO

Provider Business Mailing Address
First Line	:	6920 POINTE INVERNESS WAY STE 200
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-7934
Country	:	US
Telephone Number	:	260-479-3516
Fax Number	:	260-479-3520

Provider Business Practice Location Address
First Line	:	6515 STELLHORN RD STE 200
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46815-5436
Country	:	US
Telephone Number	:	260-458-3212
Fax Number	:	260-245-8632

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

Provider Enumeration Date	:	06/28/2017
Last Update Date	:	08/08/2024

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