Basic Information
| Provider Information | |||||||||
| NPI: | 1124087119 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARTINA | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 95 LEONARD AVE | ||||||||
| Address2: | BLDG 2 | ||||||||
| City: | WASHINGTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 153013368 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7242233100 | ||||||||
| FaxNumber: | 7242233353 | ||||||||
| Practice Location | |||||||||
| Address1: | 67 E PIKE ST | ||||||||
| Address2: | |||||||||
| City: | CANONSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 153171311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7247454100 | ||||||||
| FaxNumber: | 7457469880 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2006 | ||||||||
| LastUpdateDate: | 06/02/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | OS004282L | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 102357 | 01 | UPMC | OTHER | P001172 | 01 | GATEWAY | OTHER | 0010140650001 | 05 | PA | MEDICAID | 114908 | 01 | UNISON | OTHER | 000100946 | 01 | HIGHMARK | OTHER |