Healthcare Provider Details

I. General information

NPI: 1609893221
Provider Name (Legal Business Name): BENJAMIN J MARTIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 02/13/2020
Certification Date: 02/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 TECH CENTER DR
GAHANNA OH
43230-1987
US

IV. Provider business mailing address

701 TECH CENTER DR STE 250
GAHANNA OH
43230-1987
US

V. Phone/Fax

Practice location:
  • Phone: 614-396-2684
  • Fax: 614-396-2480
Mailing address:
  • Phone: 614-944-4800
  • Fax: 614-944-4750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number084357
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: