Provider Demographics
NPI:1649030883
Name:MARTIN, ALYSSA
Entity type:Individual
Prefix:DR
First Name:ALYSSA
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8000 5 MILE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45230-2187
Mailing Address - Country:US
Mailing Address - Phone:513-624-1240
Mailing Address - Fax:513-233-6983
Practice Address - Street 1:8000 5 MILE RD STE 100
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45230-2187
Practice Address - Country:US
Practice Address - Phone:513-624-1240
Practice Address - Fax:513-233-6983
Is Sole Proprietor?:No
Enumeration Date:2024-03-21
Last Update Date:2024-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program