MEDICARE: SEAN MARTIN

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	208C00000X	Colon & Rectal Surgery Physician	098010	OH

General Provider Information

NPI Number	:	1619282290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SEAN MARTIN

Provider Business Mailing Address
First Line	:	2460 OVERLOOK RD
Second Line	:	APARTMENT 4
City	:	CLEVELAND
State	:	OH
Zip	:	44106-2456
Country	:	US
Telephone Number	:	216-970-2294
Fax Number	:

Provider Business Practice Location Address
First Line	:	1924 E 86TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44106-2021
Country	:	US
Telephone Number	:	216-970-2294
Fax Number	:

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

Provider Enumeration Date	:	08/08/2010
Last Update Date	:	10/10/2011

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Directions to “ SEAN MARTIN ” Practice Location

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