Basic Information
Provider Information
NPI: 1851736789
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MARTIN
FirstName: ADAM
MiddleName: STEVEN
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4605 SAWMILL RD
Address2:  
City: UPPER ARLINGTON
State: OH
PostalCode: 432202246
CountryCode: US
TelephoneNumber: 6145457900
FaxNumber: 6145457901
Practice Location
Address1: 4605 SAWMILL RD
Address2:  
City: UPPER ARLINGTON
State: OH
PostalCode: 43220
CountryCode: US
TelephoneNumber: 6148278700
FaxNumber: 6148278701
Other Information
ProviderEnumerationDate: 05/06/2013
LastUpdateDate: 05/07/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/07/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207X00000X35.129004OHY Allopathic & Osteopathic PhysiciansOrthopaedic Surgery 

No ID Information.


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