Provider Demographics
NPI:1093711913
Name:WALSH, MARTIN JOHN (MD)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:JOHN
Last Name:WALSH
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 1:2000 JOSEPH E SANKER BLVD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-1979
Mailing Address - Country:US
Mailing Address - Phone:513-841-7400
Mailing Address - Fax:513-841-7402
Practice Address - Street 1:200 MEDICAL CENTER DR STE 500
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45005-5183
Practice Address - Country:US
Practice Address - Phone:513-841-7777
Practice Address - Fax:513-423-2004
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35072487208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2017310Medicaid
OHWA0825381Medicare ID - Type Unspecified
OH2017310Medicaid
OH051610Medicare PIN
OHF65375Medicare UPIN