Provider Demographics
NPI:1992919187
Name:MARTINUCCI, ERICA J (MD)
Entity type:Individual
Prefix:DR
First Name:ERICA
Middle Name:J
Last Name:MARTINUCCI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:347 BETHMOUR RD
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:CT
Mailing Address - Zip Code:06524-3358
Mailing Address - Country:US
Mailing Address - Phone:203-709-3740
Mailing Address - Fax:
Practice Address - Street 1:1320 W MAIN ST
Practice Address - Street 2:BUILDING 1, SUITE 2
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-3119
Practice Address - Country:US
Practice Address - Phone:203-709-3740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0307882083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTA60243Medicare UPIN