Healthcare Provider Details

I. General information

NPI: 1245226638
Provider Name (Legal Business Name): MARTIN B POPP MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 04/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2123 AUBURN AVE SUITE 420
CINCINNATI OH
45219-2906
US

IV. Provider business mailing address

2123 AUBURN AVE SUITE 420
CINCINNATI OH
45219-2906
US

V. Phone/Fax

Practice location:
  • Phone: 513-421-4504
  • Fax: 513-421-4507
Mailing address:
  • Phone: 513-421-4504
  • Fax: 513-421-4507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number35031878P
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: