Provider Demographics
NPI:1619195864
Name:MARTIN, DAVID WENDELL (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:WENDELL
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1709 KY ROUTE 321
Mailing Address - Street 2:SUITE 3
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653
Mailing Address - Country:US
Mailing Address - Phone:606-886-8546
Mailing Address - Fax:606-886-8548
Practice Address - Street 1:178 DOUGLAS PARKWAY
Practice Address - Street 2:
Practice Address - City:PRESTONSBURG
Practice Address - State:KY
Practice Address - Zip Code:41501-6970
Practice Address - Country:US
Practice Address - Phone:606-639-3135
Practice Address - Fax:606-639-3136
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY34359207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000523945OtherANTHEM
KY1529561OtherUMWA
KY164138200OtherFEDERAL BLACK LUNG
KY64343593Medicaid
KY611330253OtherCOMMERCIAL INS
KY000000042976OtherBLUE CROSS BLUE SHIELD
KY164138200OtherFEDERAL BLACK LUNG
KY000000042976OtherBLUE CROSS BLUE SHIELD
KY1725801Medicare PIN