Basic Information
| Provider Information | |||||||||
| NPI: | 1558565044 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARTYAK | ||||||||
| FirstName: | GREGG | ||||||||
| MiddleName: | GABRIEL | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2925 PROFESSIONAL PL | ||||||||
| Address2: | STE 201 | ||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809048133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7192604767 | ||||||||
| FaxNumber: | 7192604765 | ||||||||
| Practice Location | |||||||||
| Address1: | 1015 WALNUT ST STE 801 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191075005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159551500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2007 | ||||||||
| LastUpdateDate: | 05/17/2017 | ||||||||
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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 | 207XS0106X | MD425153 | PA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Hand Surgery |
No ID Information.