Provider Demographics
NPI:1144676438
Name:MARTINEZ, ELSA MERCEDES (MD)
Entity type:Individual
Prefix:
First Name:ELSA
Middle Name:MERCEDES
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELSA
Other - Middle Name:MERCEDES
Other - Last Name:MARTINEZ LANGUASCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:80 PHOENIX AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06702-1418
Mailing Address - Country:US
Mailing Address - Phone:203-756-8021
Mailing Address - Fax:
Practice Address - Street 1:80 PHOENIX AVE STE 201
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06702-1418
Practice Address - Country:US
Practice Address - Phone:203-756-8021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-05
Last Update Date:2020-05-04
Deactivation Date:2017-01-05
Deactivation Code:
Reactivation Date:2017-03-30
Provider Licenses
StateLicense IDTaxonomies
CT64625208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics