# MATTHEW ROBERT MARTIN

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1730153719
- **Gender:** Man
- **Credential:** PA-C

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | 10000584A | IN | Yes |
| 363A00000X | Physician Assistant | 50.002450 | OH | — |

## Other

- **Enumeration date:** 02/15/2006
- **Last updated:** 05/17/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000000767410 | ANTHEM - RPA | — |
| 05 | — | 0110849 | — | OH |
| 05 | — | OPR | — | IN |