Individual
GREGORY M MARTINO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
214 MC CRACKEN RUN ROAD, DUBOIS, PA 15801-3634
(814) 371-2577
(814) 371-2577
Mailing address
214 MC CRACKEN RUN ROAD, DUBOIS, PA 15801-3634
(814) 371-2577
(814) 371-2577
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PS008503L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0019479780003
—
PA
01
—
021494
MEDICARE IDENTIFICATION NUMBER
—
01
—
340518
HIGHMARK
—
01
—
P00067507
RAILROAD
—
Enumeration date
08/09/2005
Last updated
03/27/2014
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