Provider Demographics
NPI:1558392811
Name:MARTIN, CECIL D (MD)
Entity Type:Individual
Prefix:
First Name:CECIL
Middle Name:D
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 11TH ST
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:KY
Mailing Address - Zip Code:41008-1435
Mailing Address - Country:US
Mailing Address - Phone:502-732-3272
Mailing Address - Fax:502-732-3284
Practice Address - Street 1:309 11TH ST
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:KY
Practice Address - Zip Code:41008-1435
Practice Address - Country:US
Practice Address - Phone:502-732-3272
Practice Address - Fax:502-732-3284
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01042890207Q00000X
KY15531207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN00000076887OtherANTHEM BCBS
010065441OtherMEDICARE RAILROAD
KY1050552OtherPASSPORT KY MEDICAID
01-00445OtherUNITED HEALTHCARE
000019257QOtherHUMANA
INKY9904POtherSIHO
KY64155310Medicaid
5912036OtherAETNA
01-00445OtherUNITED HEALTHCARE
KY010065441Medicare PIN
IN00000076887OtherANTHEM BCBS
KY0875806Medicare ID - Type Unspecified