Provider Demographics
NPI:1902933286
Name:MARTINEZ, JESUS ALBERTO (MD)
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:ALBERTO
Last Name:MARTINEZ
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 1:11300 ROCKVILLE PIKE
Mailing Address - Street 2:SUITE 1202
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3003
Mailing Address - Country:US
Mailing Address - Phone:301-896-0890
Mailing Address - Fax:301-896-0968
Practice Address - Street 1:11300 ROCKVILLE PIKE
Practice Address - Street 2:SUITE 1202
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3003
Practice Address - Country:US
Practice Address - Phone:301-896-0890
Practice Address - Fax:301-896-0968
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DCMD18935207W00000X
MDD0041347207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC054782200Medicaid
MD850221800Medicaid
MDF13272Medicare UPIN