Provider Demographics
NPI:1346246576
Name:MARTIN, WILLIAM ALBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ALBERT
Last Name:MARTIN
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 1:3219 CLIFTON AVE
Mailing Address - Street 2:SUITE # 400
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45220-3027
Mailing Address - Country:US
Mailing Address - Phone:513-861-1260
Mailing Address - Fax:513-872-7149
Practice Address - Street 1:3219 CLIFTON AVE
Practice Address - Street 2:SUITE # 400
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45220-3027
Practice Address - Country:US
Practice Address - Phone:513-861-1260
Practice Address - Fax:513-872-7149
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-076911174400000X
OH350 76911207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2574638Medicaid
OHH030560Medicare PIN
OH2574638Medicaid
OHMA4168352Medicare PIN
OHMA4168351Medicare PIN
OHMA4168353Medicare PIN