Provider Demographics
NPI:1891873162
Name:MARTIN, JAY ELLIS (MD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:ELLIS
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 1:3535 FISHINGER BLVD
Mailing Address - Street 2:SUITE 285
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-7504
Mailing Address - Country:US
Mailing Address - Phone:614-527-2562
Mailing Address - Fax:614-527-2571
Practice Address - Street 1:3535 FISHINGER BLVD
Practice Address - Street 2:SUITE 285
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-7504
Practice Address - Country:US
Practice Address - Phone:614-527-2562
Practice Address - Fax:614-527-2571
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-075105207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2180198Medicaid
OH2180198Medicaid
OHH14447Medicare UPIN