Provider Demographics
NPI:1558401554
Name:MARTINSON, ERLING D
Entity type:Individual
Prefix:
First Name:ERLING
Middle Name:D
Last Name:MARTINSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 307
Mailing Address - Street 2:108 N MAIN STR
Mailing Address - City:MCVILLE
Mailing Address - State:ND
Mailing Address - Zip Code:58254
Mailing Address - Country:US
Mailing Address - Phone:701-322-4347
Mailing Address - Fax:701-322-2250
Practice Address - Street 1:108 N MAIN STREET
Practice Address - Street 2:
Practice Address - City:MCVILLE
Practice Address - State:ND
Practice Address - Zip Code:58254
Practice Address - Country:US
Practice Address - Phone:701-322-4347
Practice Address - Fax:701-322-2250
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND5150207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND13280OtherNCHS MCVILLE BLUE CROSS
ND21127OtherLAKOTA HEALTH CTR BLUE CR
NDD26115Medicare UPIN
ND13280Medicare ID - Type UnspecifiedNCHS CLINIC--MCVILLE
ND21127OtherLAKOTA HEALTH CTR BLUE CR