Provider Demographics
NPI:1730434846
Name:MARTIS, CARLYLE (MD)
Entity type:Individual
Prefix:DR
First Name:CARLYLE
Middle Name:
Last Name:MARTIS
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 1:77 GOODELL ST
Mailing Address - Street 2:UNIVERSITY AT BUFFALO, DEPARTMENT OF FAMILY MEDICINE
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14203-1243
Mailing Address - Country:US
Mailing Address - Phone:716-816-7258
Mailing Address - Fax:716-845-6699
Practice Address - Street 1:77 GOODELL ST
Practice Address - Street 2:UNIVERSITY AT BUFFALO, DEPARTMENT OF FAMILY MEDICINE
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-1243
Practice Address - Country:US
Practice Address - Phone:716-816-7258
Practice Address - Fax:716-845-6699
Is Sole Proprietor?:No
Enumeration Date:2012-07-16
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program