Provider Demographics
NPI:1447221510
Name:MARTENS, MARK G (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:G
Last Name:MARTENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 LANSING ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-1983
Mailing Address - Country:US
Mailing Address - Phone:315-255-7011
Mailing Address - Fax:315-255-7099
Practice Address - Street 1:143 NORTH ST STE 2
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-1983
Practice Address - Country:US
Practice Address - Phone:315-252-5028
Practice Address - Fax:315-252-1587
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD464152207V00000X
NJ25MA08692100207V00000X
NY320910207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ176793UUGMedicare PIN
NJC18828Medicare UPIN