Provider Demographics
NPI:1780660886
Name:MENOSKY, MARTIN E (MD)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:E
Last Name:MENOSKY
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 JACKSON PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1562
Mailing Address - Country:US
Mailing Address - Phone:740-589-3140
Mailing Address - Fax:844-261-1517
Practice Address - Street 1:2131 E STATE ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-2138
Practice Address - Country:US
Practice Address - Phone:855-446-5937
Practice Address - Fax:740-589-3127
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35071013207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000317282OtherANTHEM
510450201029OtherCARESOURCE
OH2029129Medicaid
P00060990OtherRAILROAD MEDICARE
P00060990OtherRAILROAD MEDICARE