Healthcare Provider Details

I. General information

NPI: 1144261652
Provider Name (Legal Business Name): RON T MARTINSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 08/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4581 COLUMBUS RD
CENTERBURG OH
43011-9401
US

IV. Provider business mailing address

1330 COSHOCTON AVE
MOUNT VERNON OH
43050-1440
US

V. Phone/Fax

Practice location:
  • Phone: 740-625-6234
  • Fax: 740-625-5806
Mailing address:
  • Phone: 740-625-6234
  • Fax: 740-625-5806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35-077162
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: