Provider Demographics
NPI:1811989593
Name:MARTIN, JAMES E (DO)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:E
Last Name:MARTIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3913 DARROW RD.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224
Mailing Address - Country:US
Mailing Address - Phone:330-688-7900
Mailing Address - Fax:330-688-1866
Practice Address - Street 1:3913 DARROW RD.
Practice Address - Street 2:SUITE 100
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224
Practice Address - Country:US
Practice Address - Phone:330-688-7900
Practice Address - Fax:330-688-1866
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34003458208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0527602Medicaid
OH0527602Medicaid
0853668Medicare PIN