Provider Demographics
NPI:1275564460
Name:MARTIN, BRADLEY T (MD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:T
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7324 YANKEE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:LIBERTY TWP
Mailing Address - State:OH
Mailing Address - Zip Code:45044-9096
Mailing Address - Country:US
Mailing Address - Phone:513-779-7716
Mailing Address - Fax:513-759-7163
Practice Address - Street 1:7324 YANKEE RD
Practice Address - Street 2:SUITE B
Practice Address - City:LIBERTY TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:45044-9096
Practice Address - Country:US
Practice Address - Phone:513-779-7716
Practice Address - Fax:513-759-7163
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35.031843207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHE57705Medicare UPIN
OH0651594Medicare ID - Type Unspecified