Provider Demographics
NPI:1972535771
Name:MARTINEZ, VIRGINIA (MD)
Entity type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:
Last Name:MARTINEZ
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 1:1500 POST RD STE 203
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:CT
Mailing Address - Zip Code:06820-5936
Mailing Address - Country:US
Mailing Address - Phone:203-655-8701
Mailing Address - Fax:203-655-8948
Practice Address - Street 1:1500 POST RD STE 203
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:CT
Practice Address - Zip Code:06820-5936
Practice Address - Country:US
Practice Address - Phone:203-655-8701
Practice Address - Fax:203-655-8948
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT72913207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYI25067Medicare UPIN