Basic Information
| Provider Information | |||||||||
| NPI: | 1942310941 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARTINO | ||||||||
| FirstName: | CARL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 931286 | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441931494 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8887199012 | ||||||||
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| Practice Location | |||||||||
| Address1: | 400 WABASH AVE | ||||||||
| Address2: | |||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443072433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303646000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 09/24/2008 | ||||||||
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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 | 2085R0202X | 35.047093 | OH | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 300030544 | 01 | OH | RAILROAD MEDICARE | OTHER | 58042 | 01 | OH | QUALCHOICE | OTHER | 0577291 | 05 | OH | MEDICAID | 000000025170 | 01 | OH | ANTHEM BC/BS | OTHER |