Healthcare Provider Details

I. General information

NPI: 1538146691
Provider Name (Legal Business Name): MARTIN ALAN KASSAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 06/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1536 WINCHESTER AVE SUITE 304
ASHLAND KY
41101-7662
US

IV. Provider business mailing address

1536 WINCHESTER AVE SUITE 304
ASHLAND KY
41101-7662
US

V. Phone/Fax

Practice location:
  • Phone: 606-326-9888
  • Fax: 606-324-0057
Mailing address:
  • Phone: 606-326-9888
  • Fax: 606-324-0057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number36296
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: