Provider Demographics
NPI:1952303752
Name:KELSTEN, MARTIN L (MD)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:L
Last Name:KELSTEN
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:PO BOX 20452
Mailing Address - Street 2:CORPATH CRED
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-0452
Mailing Address - Country:US
Mailing Address - Phone:614-442-2406
Mailing Address - Fax:614-442-2410
Practice Address - Street 1:7500 HOSPITAL DR
Practice Address - Street 2:DUBLIN METHODIST HOSPITAL PATHOLOGY DEPT
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-8518
Practice Address - Country:US
Practice Address - Phone:614-544-8356
Practice Address - Fax:614-544-8091
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35059066207ZC0500X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0761331Medicaid
OH220023476OtherRR MEDICARE
OH0761331Medicaid