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General NPI Number Information
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NPI Number | 1124328182
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Entity Type | Organization
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Legal Business Name | THEODORE S MARTY MD INC
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Dates
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Enumeration Date | 10/25/2010
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Last Update Date | 02/24/2011
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Provider Practice Location Address
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Address Line | 1507 SPRINGFIELD PIKE
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City | CINCINNATI
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State | OH
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Zip | 45215-1437
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Country | US
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Telephone | 513-821-6500
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Fax | 513-821-4333
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Provider Business Mailing Address
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Address Line | PO BOX 636995
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City | CINCINNATI
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State | OH
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Zip | 45263-0001
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Country | US
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Telephone | 513-821-6500
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Fax | 513-821-4333
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Authorized Official
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Title or Position | PHYSICIAN
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Name | MR. THEODORE S MARTY III
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Credential | MD
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Telephone | 513-821-6500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 35057786M
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License Number State | OH
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