Provider Demographics
NPI:1134447410
Name:MARTIN, MATTHEW SCOTT (DO)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:SCOTT
Last Name:MARTIN
Suffix:
Gender:M
Credentials:DO
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Other - First Name:
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Mailing Address - Street 1:1698 OLD LEBANON RD
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42718-9662
Mailing Address - Country:US
Mailing Address - Phone:270-789-6087
Mailing Address - Fax:270-789-6119
Practice Address - Street 1:125 KINGSWOOD DR
Practice Address - Street 2:
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718
Practice Address - Country:US
Practice Address - Phone:270-789-1112
Practice Address - Fax:270-789-6175
Is Sole Proprietor?:No
Enumeration Date:2010-05-11
Last Update Date:2018-06-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY03558208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics