Provider Demographics
NPI:1194813543
Name:MARTINELLI, PAUL T (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:T
Last Name:MARTINELLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:3585 NATIONAL DR STE 150
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-0138
Mailing Address - Country:US
Mailing Address - Phone:469-467-6647
Mailing Address - Fax:469-467-6648
Practice Address - Street 1:3585 NATIONAL DR STE 150
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75025-0138
Practice Address - Country:US
Practice Address - Phone:469-467-6647
Practice Address - Fax:469-467-6648
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL8826207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8J9146Medicare PIN