Provider Demographics
NPI:1033738646
Name:OWEN, MARTIN GERHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:GERHARD
Last Name:OWEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 BRAYBARTON BLVD
Mailing Address - Street 2:
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43952
Mailing Address - Country:US
Mailing Address - Phone:403-970-6936
Mailing Address - Fax:
Practice Address - Street 1:1800 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:TORONTO
Practice Address - State:OH
Practice Address - Zip Code:43964-1949
Practice Address - Country:US
Practice Address - Phone:740-264-8781
Practice Address - Fax:740-346-0091
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-14
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC83062207Q00000X
OH35.146467207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0007642Medicaid