Provider Demographics
NPI:1962581249
Name:MARTYNOWICZ, MAREK A (MD)
Entity type:Individual
Prefix:
First Name:MAREK
Middle Name:A
Last Name:MARTYNOWICZ
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 1:4620 VIRGO AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99516-5301
Mailing Address - Country:US
Mailing Address - Phone:907-222-1725
Mailing Address - Fax:907-222-1726
Practice Address - Street 1:3260 PROVIDENCE DR STE 523
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4608
Practice Address - Country:US
Practice Address - Phone:907-222-1725
Practice Address - Fax:907-222-1726
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1382207RP1001X
AKMEDS6690207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1009470Medicaid
TX142184401Medicaid
TX142184402Medicaid
TX142184404Medicaid
TX8763M0Medicare PIN
TX142184402Medicaid
TX8258M1Medicare PIN
TX142184404Medicaid