Provider Demographics
NPI:1104023795
Name:MARTIN, LUKE WELDON (MD)
Entity Type:Individual
Prefix:DR
First Name:LUKE
Middle Name:WELDON
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4605 MACCORKLE AVE SW
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25309-1311
Mailing Address - Country:US
Mailing Address - Phone:304-414-4800
Mailing Address - Fax:304-414-4801
Practice Address - Street 1:331 LAIDLEY ST STE 503
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-1682
Practice Address - Country:US
Practice Address - Phone:304-205-7912
Practice Address - Fax:304-205-4694
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV22900208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810018434Medicaid
WV6336732OtherCIGNA
WVB441OtherMEDICARE GROUP NUMBER
WV1104023795Other4-MOST
WV3810024049OtherMEDICAID GROUP NUMBER
WV1104023795Other4-MOST
WV$$$$$$$$$OtherMSBCBS
WVWV1170B441Medicare PIN
1104023795OtherCARELINK
272533700OtherWELLS FARGO (PEIA)
1457662597OtherTRICARE NORTH
615411900OtherUS DEPARTMENT OF LABOR
WV6336732OtherCIGNA