Basic Information
| Provider Information | |||||||||
| NPI: | 1366679581 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THOMAS JOSEPH MARTINELLI MD A PROFESSIONAL CORP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1225 MARSHALL ST STE 7 | ||||||||
| Address2: | |||||||||
| City: | CRESCENT CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 955312281 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074641989 | ||||||||
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| Practice Location | |||||||||
| Address1: | 413 MILL BEACH RD | ||||||||
| Address2: | |||||||||
| City: | BROOKINGS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974159690 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074641989 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2009 | ||||||||
| LastUpdateDate: | 06/15/2009 | ||||||||
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| AuthorizedOfficialLastName: | MARTINELLI | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | JOSEPH | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7074583563 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | G042174 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.