Basic Information
| Provider Information | |||||||||
| NPI: | 1063659225 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VENDRAME | ||||||||
| FirstName: | MARTINA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | ONE MEDICAL CTR BLVD ACP 533 | ||||||||
| Address2: | HAN NEUROLOGICAL | ||||||||
| City: | UPLAND | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190133902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108741184 | ||||||||
| FaxNumber: | 6108744258 | ||||||||
| Practice Location | |||||||||
| Address1: | 1250 S CEDAR CREST BLVD STE 405 | ||||||||
| Address2: | |||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181036224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104028420 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2009 | ||||||||
| LastUpdateDate: | 08/01/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 204D00000X | 36129378 | IL | N | Allopathic & Osteopathic Physicians | Neuromusculoskeletal Medicine & OMM | 207RS0012X | 070921 | GA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Sleep Medicine | 207RS0012X | 36129378 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Sleep Medicine | 2084N0400X | MD458011 | PA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 003139553A | 05 | GA | MEDICAID |