Provider Demographics
NPI:1245226638
Name:POPP, MARTIN B (MD)
Entity Type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:B
Last Name:POPP
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 1:2123 AUBURN AVE
Mailing Address - Street 2:SUITE 420
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2906
Mailing Address - Country:US
Mailing Address - Phone:513-421-4504
Mailing Address - Fax:513-421-4507
Practice Address - Street 1:2123 AUBURN AVE
Practice Address - Street 2:SUITE 420
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2906
Practice Address - Country:US
Practice Address - Phone:513-421-4504
Practice Address - Fax:513-421-4507
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-21
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35031878P2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0413163Medicaid
OH0921293Medicaid
KY64766744Medicaid
IN100394580Medicaid
IN200100530AMedicaid
OH0921293Medicaid
IN100394580Medicaid