Individual
DR. M NICHOLAS MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4925 ROCKWELL RD, WINCHESTER, KY 40391-8509
(859) 744-1061
(859) 744-1062
Mailing address
4925 ROCKWELL RD, WINCHESTER, KY 40391-8509
(859) 744-1061
(859) 744-1062
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
17782
KY
207Q00000X
Family Medicine Physician
24668
IN
207QB0002X
Obesity Medicine (Family Medicine) Physician
Primary
17782
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000045743
ANTHEM
—
05
—
065909137
—
KY
01
—
5910070
AETNA
—
01
—
610882170
VARIABLE TAX ID
—
01
—
64177827
UNISYS
KY
01
—
80031821
MEDICAARE PALMETTO GBA
—
Enumeration date
01/09/2007
Last updated
05/08/2014
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