Provider Demographics
NPI:1508072976
Name:MARTIN, DEWAN EUGENE
Entity Type:Individual
Prefix:MR
First Name:DEWAN
Middle Name:EUGENE
Last Name:MARTIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1579 MORTON CT
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:OH
Mailing Address - Zip Code:43119-9307
Mailing Address - Country:US
Mailing Address - Phone:614-338-5321
Mailing Address - Fax:
Practice Address - Street 1:1579 MORTON CT
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:OH
Practice Address - Zip Code:43119-9307
Practice Address - Country:US
Practice Address - Phone:614-338-5321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2492619Medicaid