Provider Demographics
NPI:1124087119
Name:MARTINA, PETER A (DO)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:A
Last Name:MARTINA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 LEONARD AVE
Mailing Address - Street 2:BLDG 2
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-3368
Mailing Address - Country:US
Mailing Address - Phone:724-223-3100
Mailing Address - Fax:724-223-3353
Practice Address - Street 1:67 E PIKE ST
Practice Address - Street 2:
Practice Address - City:CANONSBURG
Practice Address - State:PA
Practice Address - Zip Code:15317-1311
Practice Address - Country:US
Practice Address - Phone:724-745-4100
Practice Address - Fax:745-746-9880
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS004282L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
102357OtherUPMC
P001172OtherGATEWAY
PA0010140650001Medicaid
114908OtherUNISON
000100946OtherHIGHMARK
100946JXYMedicare PIN
P001172OtherGATEWAY
000100946OtherHIGHMARK