Provider Demographics
NPI:1811995558
Name:MARTIN, STEVEN DOUGLAS (APRN)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:DOUGLAS
Last Name:MARTIN
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:STEVE
Other - Middle Name:DOUGLAS
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN
Mailing Address - Street 1:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-426-0800
Mailing Address - Fax:859-426-4140
Practice Address - Street 1:1 MEDICAL VILLAGE DRIVE
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017-3403
Practice Address - Country:US
Practice Address - Phone:859-301-2000
Practice Address - Fax:859-426-4140
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH07307363L00000X
OHNP-07307363LF0000X
KY3002999363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0562617OtherMEDICARE
KY0369211OtherMEDICARE
OH611300608058OtherCARESOURCE
KY78003274Medicaid
KY0369017OtherMEDICARE
KY0369017OtherMEDICARE
KY0562617OtherMEDICARE
S89958Medicare UPIN
KY0369017Medicare ID - Type UnspecifiedMEDICARE NUMBER
KY0369211Medicare ID - Type UnspecifiedMEDICARE NUMBER
OHMANP18901Medicare PIN
KYP400022625Medicare PIN