MEDICARE: BIANCA MARIE MARTINEZ MD

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	390200000X	Student in an Organized Health Care Education/Training Program
2	390200000X	Student in an Organized Health Care Education/Training Program	315366	NC

General Provider Information

NPI Number	:	1912657586
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BIANCA MARIE MARTINEZ MD

Provider Business Mailing Address
First Line	:	2000 OLD CLINIC CB# 7510
Second Line	:
City	:	CHAPEL HILL
State	:	NC
Zip	:	27599-0001
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 OLD CLINIC CB# 7510
Second Line	:
City	:	CHAPEL HILL
State	:	NC
Zip	:	27599-4603
Country	:	US
Telephone Number	:	919-445-6985
Fax Number	:	919-962-9625

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

Provider Enumeration Date	:	03/26/2022
Last Update Date	:	05/10/2023

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