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NPI Code Detail

MEDICARE: THEODORE S MARTY MD INC

MEDICARE: THEODORE S MARTY MD INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician35057786MOH

General Provider Information

NPI Number : 1124328182
Entity Type Code : Organization
Provider Name (Legal Business Name) : THEODORE S MARTY MD INC
Provider Business Mailing Address
First Line : PO BOX 636995
Second Line :
City : CINCINNATI
State : OH
Zip : 45263-0001
Country : US
Telephone Number : 513-821-6500
Fax Number : 513-821-4333
Provider Business Practice Location Address
First Line : 1507 SPRINGFIELD PIKE
Second Line :
City : CINCINNATI
State : OH
Zip : 45215-1437
Country : US
Telephone Number : 513-821-6500
Fax Number : 513-821-4333
Authorized Official
Title or Position : PHYSICIAN
Name : MR. THEODORE S MARTY III
Credential : MD
Telephone Number : 513-821-6500
Provider Enumeration Date : 10/25/2010
Last Update Date : 02/24/2011

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Directions to “THEODORE S MARTY MD INC ” Practice Location

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