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CARIDAD PONCE MARTINEZ

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
100 CENTURY DR, WORCESTER, MA 01606-1244
(508) 762-5400
(508) 762-5410
Mailing address
PO BOX 415348, BOSTON, MA 02241-5348
(800) 225-8885
(508) 334-1977

Taxonomy

Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
265858
MA
2084P0800X
Psychiatry Physician
54141
CT
2084P0802X
Addiction Psychiatry Physician
54141
CT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
004041000
MEDICAID ACCESS CENTER
CT
01
004082260
LEGION MEDICAID
CT
01
004217099
MEDICAID PCS LONG WHARF
CT
01
008001325
LEGION MEDICAID
CT
01
008003745
MEDICAID ACCESS CENTER
CT
01
008022622
LEGION MEDICAID
CT
05
110114551A
MA
01
D400249296
PONCE MARTINEZ MEDICARE
CT
01
S400316833
MEDICARE
MA
Enumeration date
04/18/2011
Last updated
10/27/2020
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