Provider Demographics
NPI:1487947503
Name:MARTYNIUK, JOHN W (PHD, MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:MARTYNIUK
Suffix:
Gender:M
Credentials:PHD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8820
Mailing Address - Street 2:777 EAST PARK DRIVE
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17105
Mailing Address - Country:US
Mailing Address - Phone:717-558-7819
Mailing Address - Fax:717-558-7818
Practice Address - Street 1:777 EAST PARK DRIVE
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17105
Practice Address - Country:US
Practice Address - Phone:717-558-7819
Practice Address - Fax:717-558-7818
Is Sole Proprietor?:No
Enumeration Date:2011-05-23
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD043470L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAF69214Medicare UPIN