Provider Demographics
NPI:1750372843
Name:CANALES, MARTA DINORA (MD)
Entity type:Individual
Prefix:DR
First Name:MARTA
Middle Name:DINORA
Last Name:CANALES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2075 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-2516
Mailing Address - Country:US
Mailing Address - Phone:516-771-4582
Mailing Address - Fax:
Practice Address - Street 1:2167 GRAND AVE
Practice Address - Street 2:1F
Practice Address - City:NORTH BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-2918
Practice Address - Country:US
Practice Address - Phone:516-771-4582
Practice Address - Fax:516-771-4583
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY215758208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics