Provider Demographics
NPI:1225020399
Name:MARTIN, ROBERT CRAIG (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:CRAIG
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:R.
Other - Middle Name:CRAIG
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1221 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-2701
Mailing Address - Country:US
Mailing Address - Phone:829-258-6200
Mailing Address - Fax:859-258-6203
Practice Address - Street 1:1138 LEXINGTON RD
Practice Address - Street 2:SUITE 290
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-9672
Practice Address - Country:US
Practice Address - Phone:502-863-0721
Practice Address - Fax:502-863-6104
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY29629207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64296296Medicaid
KY1558701Medicare ID - Type Unspecified
KYF57897Medicare UPIN