Provider Demographics
NPI:1245559749
Name:MARTINSON, MATTHEW J (PA-C)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:J
Last Name:MARTINSON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3480 YORKSHIRE MEDICAL PARK
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1886
Mailing Address - Country:US
Mailing Address - Phone:859-263-5140
Mailing Address - Fax:859-263-5141
Practice Address - Street 1:1868 PLAUDIT PL
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-2429
Practice Address - Country:US
Practice Address - Phone:859-263-5140
Practice Address - Fax:859-263-5141
Is Sole Proprietor?:No
Enumeration Date:2010-05-24
Last Update Date:2017-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTC947363A00000X
KYPA2093363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL684210013Medicare PIN