MEDICARE: DR. MARTIN HASKELL MD

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
1	207VG0400X	Gynecology Physician	35-037358	OH
2	207VG0400X	Gynecology Physician	01055214A	IN

General Provider Information

NPI Number	:	1215088018
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARTIN HASKELL MD

Provider Business Mailing Address
First Line	:	PO BOX 43100
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45243-0100
Country	:	US
Telephone Number	:	513-272-0002
Fax Number	:	513-272-0052

Provider Business Practice Location Address
First Line	:	1401 E STROOP RD
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45429-4927
Country	:	US
Telephone Number	:	937-293-7324
Fax Number	:	937-293-1269

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	07/08/2007

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