Provider Demographics
NPI:1912983859
Name:MARTIN, JOSEPH E (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:E
Last Name:MARTIN
Suffix:
Gender:M
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: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:859-485-4116
Mailing Address - Fax:859-485-1389
Practice Address - Street 1:13260 SERVICE RD
Practice Address - Street 2:
Practice Address - City:WALTON
Practice Address - State:KY
Practice Address - Zip Code:41094-9565
Practice Address - Country:US
Practice Address - Phone:859-485-4116
Practice Address - Fax:859-485-1389
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35086287207R00000X
KY41770208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100057350Medicaid
KYP00633290OtherRAILROAD MEDICARE
KYP00883415OtherRAILROAD MEDICARE
OH2598934Medicaid
OHI37229Medicare UPIN
KY7100057350Medicaid
KY0400028Medicare PIN
KYP00883415OtherRAILROAD MEDICARE