Provider Demographics
NPI:1285322834
Name:MARTIN, IRENE NZISA (MD)
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:NZISA
Last Name:MARTIN
Suffix:
Gender:F
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:UMASS CHAN MEDICAL SCHOOL, PEDIATRICS DEPARTMENT
Mailing Address - Street 2:55N LAKE AVENUE
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01655
Mailing Address - Country:US
Mailing Address - Phone:774-670-8355
Mailing Address - Fax:
Practice Address - Street 1:UMASS CHAN MEDICAL SCHOOL, PEDIATRICS DEPARTMENT
Practice Address - Street 2:55N LAKE AVENUE
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01655
Practice Address - Country:US
Practice Address - Phone:774-670-8355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-01
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program