Provider Demographics
NPI:1881682698
Name:MCMARTIN, DANIEL E (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:E
Last Name:MCMARTIN
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 1:10216 TAYLORSVILLE RD
Mailing Address - Street 2:SUITE 900
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-3616
Mailing Address - Country:US
Mailing Address - Phone:502-261-2183
Mailing Address - Fax:502-240-6481
Practice Address - Street 1:225 ABRAHAM FLEXNER WAY
Practice Address - Street 2:SUITE 305
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1846
Practice Address - Country:US
Practice Address - Phone:502-585-4321
Practice Address - Fax:502-587-8306
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY16926207RC0000X
IN01039871A207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64169261Medicaid
KYP00336128OtherRAILROAD MEDICARE
IN200009360Medicaid
KY060057269OtherRAILROAD MEDICARE
IN060014168OtherRAILROAD MEDICARE
KY00311001Medicare PIN
KY64169261Medicaid
KY0690812Medicare PIN
KY00310001Medicare PIN
KY00312001Medicare PIN
KY00314001Medicare PIN
IN200009360Medicaid
IN126930FMedicare PIN
KY00308001Medicare PIN
KYP00336128OtherRAILROAD MEDICARE
IN060014168OtherRAILROAD MEDICARE
C65352Medicare UPIN
KY00546061Medicare Oscar/Certification
IN228550DMedicare PIN
KY00313001Medicare PIN