Provider Demographics
NPI:1437176922
Name:MARTIN, ERNEST CLEAGE (MD)
Entity Type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:CLEAGE
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 1:309 WEST BELTLINE BLVD.
Mailing Address - Street 2:NORTH HILL PROFESSIONAL PARK
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29625-1505
Mailing Address - Country:US
Mailing Address - Phone:864-261-9506
Mailing Address - Fax:864-225-1134
Practice Address - Street 1:309 W BELTLINE BLVD
Practice Address - Street 2:NORTH HILL PROFESSIONAL PARK
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29625-1505
Practice Address - Country:US
Practice Address - Phone:864-261-9506
Practice Address - Fax:864-225-1134
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC157402084F0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3908Medicaid
SCF040148004Medicare UPIN
SCGP3908Medicaid