Provider Demographics
NPI:1902892714
Name:MARTINEZ, JORGE L (MD)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:L
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:101 UNION AVE
Mailing Address - Street 2:SUITE 601
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13203-2761
Mailing Address - Country:US
Mailing Address - Phone:315-234-0906
Mailing Address - Fax:315-234-4416
Practice Address - Street 1:4900 BROAD RD
Practice Address - Street 2:CGH POB 2H
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13215-2265
Practice Address - Country:US
Practice Address - Phone:315-492-5973
Practice Address - Fax:315-492-5698
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-27
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
NY195479207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
C79804Medicare UPIN