Provider Demographics
NPI:1184833386
Name:DR. RICHARD L. MARTIN JR L.L.C
Entity Type:Organization
Organization Name:DR. RICHARD L. MARTIN JR L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:740-695-4410
Mailing Address - Street 1:107 PLAZA DR
Mailing Address - Street 2:STE S
Mailing Address - City:SAINT CLAIRSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43950-8786
Mailing Address - Country:US
Mailing Address - Phone:740-695-4410
Mailing Address - Fax:740-695-5440
Practice Address - Street 1:107 PLAZA DR
Practice Address - Street 2:STE S
Practice Address - City:SAINT CLAIRSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43950-8786
Practice Address - Country:US
Practice Address - Phone:740-695-4410
Practice Address - Fax:740-695-5440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003308M213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2338992Medicaid
OH2338992Medicaid
OH9348031Medicare PIN