Provider Demographics
NPI:1629033246
Name:ANSAH, MARTINSON A (MD)
Entity Type:Individual
Prefix:
First Name:MARTINSON
Middle Name:A
Last Name:ANSAH
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 1:1249 15TH ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701
Mailing Address - Country:US
Mailing Address - Phone:304-691-1000
Mailing Address - Fax:304-691-1693
Practice Address - Street 1:1249 15TH ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701
Practice Address - Country:US
Practice Address - Phone:304-691-1000
Practice Address - Fax:304-691-1693
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV21665207R00000X
OH35.085353207R00000X
TN42883207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2490746Medicaid
WV3810000237Medicaid
KY64083991Medicaid
WV3810000237Medicaid
KY64083991Medicaid