Provider Demographics
NPI:1841292018
Name:MARTIN, PAUL A (DO)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:A
Last Name:MARTIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:2912 SPRINGBORO W
Mailing Address - Street 2:STE 201
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45439-1674
Mailing Address - Country:US
Mailing Address - Phone:937-297-8999
Mailing Address - Fax:937-277-8618
Practice Address - Street 1:77 E WOODBURY DR
Practice Address - Street 2:SUITE 110
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-2855
Practice Address - Country:US
Practice Address - Phone:937-277-1722
Practice Address - Fax:937-277-8618
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34002694M207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH421534506031OtherCARESOURCE
OHD0269405OtherHUMANA/CHOICECARE
OH000000227892OtherUNICARE
OH0486782Medicaid
OH080191708OtherRAILROAD MEDICARE
OH34002694MOtherMEDICAL LICENSE
OH000000227892OtherANTHEM
OH0120333OtherUNITED HEALTHCARE
OH660537OtherAETNA
OHE00641Medicare UPIN
OH0486782Medicaid