Basic Information
| Provider Information | |||||||||
| NPI: | 1700964848 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARTENTS | ||||||||
| FirstName: | MARTHA | ||||||||
| MiddleName: | N | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 48 SUMMER STREET | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | WATERTOWN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024723815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6179265222 | ||||||||
| FaxNumber: | 6179265999 | ||||||||
| Practice Location | |||||||||
| Address1: | 725 CONCORD AVE STE 6100 | ||||||||
| Address2: | |||||||||
| City: | CAMBRIDGE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021381040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 1617864882 | ||||||||
| FaxNumber: | 6175475367 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2006 | ||||||||
| LastUpdateDate: | 10/18/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 150095 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 3149358 | 05 | MA | MEDICAID | 110206268 | 01 | MA | RAILROAD MEDICARE | OTHER |