Provider Demographics
NPI:1235170572
Name:MARTINI, DAVID V (MD, PA)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:V
Last Name:MARTINI
Suffix:
Gender:
Credentials:MD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:605-328-9419
Mailing Address - Fax:410-620-1538
Practice Address - Street 1:701 E ROSSER AVE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-4457
Practice Address - Country:US
Practice Address - Phone:701-323-8550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0006640207Y00000X, 2086S0122X
MDD0059096207Y00000X, 2086S0122X
GA80480207Y00000X
ND22023207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD405979400OtherGROUP MEDICAID ID
DE1508811928OtherGROUP MEDICAID ID
MD500M759FOtherINDIVIDUAL MEDICARE PTAN
DE248474YJQXOtherINDIVIDUAL MEDICARE PTAN
DE1235170572OtherINDIVIDUAL MEDICAID ID
DE248471OtherGROUP MEDICARE PTAN
MD500MOtherGROUP MEDICARE PTAN
GA80480OtherMEDICAL LICENSE
MD512502200OtherINDIVIDUAL MEDICAID ID
MDP00209459OtherMEDICARE RAILROAD