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Individual

MR. THOMAS MARTIN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
RN, CRNA

Contact information

Practice address
2000 JOSEPH E. SANKER BOULEVARD, CINCINNATI, OH 45212
(513) 204-5696
(877) 284-4283
Mailing address
4549 RAYNOR COURT, MASON, OH 45040
(513) 204-5696
(877) 284-4283

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
117984
OH
207L00000X
Anesthesiology Physician
NA029000
OH
367500000X
Certified Registered Nurse Anesthetist
Primary
029000
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000273426
ANTHEM
05
0763115
OH
05
200424830
IN
01
617585
WELLCARE
KY
01
728028
BUCKEYE
05
74003724
KY
Enumeration date
06/07/2006
Last updated
02/04/2016
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