Individual
CHARLES MARTINO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4240 BIRDELLA DR, WILLIAMSBURG, VA 23188-7366
(757) 426-4041
(757) 657-4353
Mailing address
4240 BIRDELLA DR, WILLIAMSBURG, VA 23188-7366
(757) 426-4041
(757) 657-4353
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
46-3128729
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0173029148
—
VA
Enumeration date
04/13/2015
Last updated
04/13/2015
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