Healthcare Provider Details

I. General information

NPI: 1457453805
Provider Name (Legal Business Name): BRYAN L. MARTIN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 02/15/2021
Certification Date: 02/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 OLENTANGY RIVER RD STE 4000
COLUMBUS OH
43212-3154
US

IV. Provider business mailing address

700 ACKERMAN RD STE 2120
COLUMBUS OH
43202-1559
US

V. Phone/Fax

Practice location:
  • Phone: 614-366-3687
  • Fax: 614-293-6176
Mailing address:
  • Phone: 614-293-2594
  • Fax: 614-293-4487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number34.003921
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number34-00-3921
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: