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General NPI Number Information
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NPI Number | 1447259270
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Entity Type | Individual
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Provider Name | CHARLES MARTY MD
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Gender | Male
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Dates
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Enumeration Date | 07/14/2005
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Last Update Date | 02/25/2014
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Provider Practice Location Address
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Address Line | 1865 TAMARACK RD
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City | NEWARK
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State | OH
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Zip | 43055-1350
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Country | US
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Telephone | 740-348-4972
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Fax | 740-348-4991
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Provider Business Mailing Address
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Address Line | 1865 TAMARACK RD
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City | NEWARK
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State | OH
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Zip | 43055-1350
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Country | US
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Telephone | 740-348-4972
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Fax | 740-348-4991
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083X0100X
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Taxonomy Name | Occupational Medicine Physician
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License Number | 35.042030
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License Number State | OH
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