Basic Information
Provider Information | |||||||||
NPI: | 1467697375 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MARTINEZ | ||||||||
FirstName: | LEONARDO | ||||||||
MiddleName: | A. | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | MARTINEZ ROWE | ||||||||
OtherFirstName: | LEONARDO | ||||||||
OtherMiddleName: | ADRIAN | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | M.D. | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 101 MANNING DR | ||||||||
Address2: | CB 7010 DEPT OF ANESTHESIOLOGY | ||||||||
City: | CHAPEL HILL | ||||||||
State: | NC | ||||||||
PostalCode: | 275997010 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9199665136 | ||||||||
FaxNumber: | 9849744873 | ||||||||
Practice Location | |||||||||
Address1: | 101 MANNING DR | ||||||||
Address2: | CB 7010 DEPT OF ANESTHESIOLOGY | ||||||||
City: | CHAPEL HILL | ||||||||
State: | NC | ||||||||
PostalCode: | 275997010 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9199665136 | ||||||||
FaxNumber: | 9849744873 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/05/2008 | ||||||||
LastUpdateDate: | 04/20/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 0101252132 | VA | N |   | Allopathic & Osteopathic Physicians | Anesthesiology |   | 207LP3000X | 2016-01758 | NC | Y |   | Allopathic & Osteopathic Physicians | Anesthesiology | Pediatric Anesthesiology |
No ID Information.