Provider Demographics
NPI:1144207747
Name:MARTIN, CHARLES T (DPM)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:T
Last Name:MARTIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 SMITH RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-2787
Mailing Address - Country:US
Mailing Address - Phone:513-619-6885
Mailing Address - Fax:513-533-6001
Practice Address - Street 1:5903 WOLFPEN PLEASANT HILL RD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:OH
Practice Address - Zip Code:45150-2132
Practice Address - Country:US
Practice Address - Phone:513-831-7503
Practice Address - Fax:513-831-7923
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-00-1914-M213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0790658Medicaid
OHT80476Medicare UPIN
0698420005Medicare NSC
OH0790658Medicaid
0698420007Medicare NSC