Provider Demographics
NPI:1063425742
Name:MARTENSON, ANDERS III (MD)
Entity type:Individual
Prefix:
First Name:ANDERS
Middle Name:
Last Name:MARTENSON
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1417
Mailing Address - Street 2:260 CENTER ST
Mailing Address - City:MIDDLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02346-4417
Mailing Address - Country:US
Mailing Address - Phone:508-946-1555
Mailing Address - Fax:508-947-6731
Practice Address - Street 1:260 CENTER ST
Practice Address - Street 2:
Practice Address - City:MIDDLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02346
Practice Address - Country:US
Practice Address - Phone:508-946-1555
Practice Address - Fax:508-947-6731
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA51871208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3004708Medicaid
1201921OtherUNITED HEALTHCARE
000000026495OtherBMC HEALTH NET PLAN
MA051871OtherTUFTS
MAJ05085OtherBCBS
20145OtherHARVARD PILGRIM
MAJ05085OtherBCBS
E03138Medicare UPIN