MEDICARE: DR. STUART MARTIN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	21427	KY
2	207RA0401X	Addiction Medicine (Internal Medicine) Physician	21427	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093707564
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STUART MARTIN M.D.

Provider Business Mailing Address
First Line	:	4 WATERS EDGE PL
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40502-2612
Country	:	US
Telephone Number	:	859-266-5604
Fax Number	:

Provider Business Practice Location Address
First Line	:	2375 PROFESSIONAL HEIGHTS DR
Second Line	:	SUITE 210
City	:	LEXINGTON
State	:	KY
Zip	:	40503-3040
Country	:	US
Telephone Number	:	859-317-9159
Fax Number	:	859-309-0277

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2005
Last Update Date	:	04/11/2014

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Directions to “ DR. STUART MARTIN M.D.” Practice Location

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