Provider Demographics
NPI:1861554180
Name:MARTINEZ, RAFAEL (MD)
Entity type:Individual
Prefix:
First Name:RAFAEL
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RAFAEL
Other - Middle Name:ERNESTO
Other - Last Name:MARTINEZ-RUIZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:100 N ACADEMY AVE # MC4903
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-9800
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:
Practice Address - Street 1:1800 MULBERRY ST
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18510-2369
Practice Address - Country:US
Practice Address - Phone:570-703-8259
Practice Address - Fax:570-703-7250
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD431183207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2849065000OtherIBC
PA30042529OtherKEYSTONE MERCY
PA1018097010001Medicaid
PA20062974OtherAMERIHEALTH MERCY
PA50070419OtherCAPITAL ADVANTAGE
PA821628Other1ST HEALTH PRIORITY
PA000000213116OtherUNISON
PA1957631OtherHIGHMARK
PA50070419OtherCAPITAL ADVANTAGE
PA821628Other1ST HEALTH PRIORITY
PA1018097010001Medicaid