Provider Demographics
NPI:1194727834
Name:MARTINEZ, EDUARDO P (MD)
Entity type:Individual
Prefix:DR
First Name:EDUARDO
Middle Name:P
Last Name:MARTINEZ
Suffix:
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 1:1720 COOPER FOSTER PARK RD W
Mailing Address - Street 2:SUITE B
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-4200
Mailing Address - Country:US
Mailing Address - Phone:440-989-4480
Mailing Address - Fax:440-989-4484
Practice Address - Street 1:1720 COOPER FOSTER PARK RD W
Practice Address - Street 2:SUITE B
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-4200
Practice Address - Country:US
Practice Address - Phone:440-989-4480
Practice Address - Fax:440-989-4484
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350437242085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH482197Medicaid
OH482197Medicaid
OHMA0575602Medicare PIN