Provider Demographics
NPI:1861935165
Name:WYOMING PSYCHIATRY, LLC
Entity type:Organization
Organization Name:WYOMING PSYCHIATRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRY
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTORANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-215-9870
Mailing Address - Street 1:301 S FENWAY ST STE 201
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-3053
Mailing Address - Country:US
Mailing Address - Phone:307-215-9870
Mailing Address - Fax:307-333-0389
Practice Address - Street 1:301 S FENWAY ST
Practice Address - Street 2:SUITE 201
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-3051
Practice Address - Country:US
Practice Address - Phone:307-215-9870
Practice Address - Fax:307-333-0389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-18
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY9017A207LA0401X, 2084P0802X, 208VP0000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No207LA0401XAllopathic & Osteopathic PhysiciansAnesthesiologyAddiction MedicineGroup - Single Specialty
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction PsychiatryGroup - Single Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty