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General NPI Number Information
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NPI Number | 1639436900
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Entity Type | Individual
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Provider Name | DOUGLAS JOSEPH MARTIN MD, PHD
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Gender | Male
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Dates
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Enumeration Date | 04/11/2012
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Last Update Date | 09/23/2024
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Provider Practice Location Address
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Address Line | 9500 EUCLID AVE
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City | CLEVELAND
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State | OH
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Zip | 44195-0341
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Country | US
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Telephone | 216-444-1084
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Fax |
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Provider Business Mailing Address
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Address Line | 3 PEBBLEBROOK LN
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City | MORELAND HILLS
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State | OH
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Zip | 44022-2300
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Country | US
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Telephone | 507-269-8869
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Fax |
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 35.136059
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 2085N0700X
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Taxonomy Name | Neuroradiology Physician
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License Number | 35.136059
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License Number State | OH
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