Provider Demographics
NPI:1447703202
Name:MARTORANA, PEGGY SUE
Entity type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:SUE
Last Name:MARTORANA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883-2843
Mailing Address - Country:US
Mailing Address - Phone:419-443-1446
Mailing Address - Fax:
Practice Address - Street 1:159 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-2843
Practice Address - Country:US
Practice Address - Phone:419-443-1446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-28
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2260155Medicaid