Provider Demographics
NPI:1528061876
Name:FAMMARTINO, JOSEPH JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:JAMES
Last Name:FAMMARTINO
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 1:9800 LEVIN RD NW STE 203
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-7849
Mailing Address - Country:US
Mailing Address - Phone:360-307-0300
Mailing Address - Fax:360-307-0302
Practice Address - Street 1:4676 DOUGLAS CIR NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-3619
Practice Address - Country:US
Practice Address - Phone:330-494-1116
Practice Address - Fax:330-494-0276
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2006-0840207W00000X
WAMD60275755207W00000X
OH35040894207W00000X
PAMD040856E207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1256825/03Medicaid
NM87356023Medicaid
OH0405903Medicaid
OH0405903Medicaid
NM87356023Medicaid
348707202Medicare PIN
PAFA026292LXDMedicare ID - Type Unspecified