MEDICARE: LARRY CHRISTOPHER MARTIN MD

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	2086S0102X	Surgical Critical Care Physician	35070212	OH
2	2086S0102X	Surgical Critical Care Physician	21366	MS

General Provider Information

NPI Number	:	1578516704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARRY CHRISTOPHER MARTIN MD

Provider Business Mailing Address
First Line	:	700 ACKERMAN RD STE 2120
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43202-1559
Country	:	US
Telephone Number	:	614-293-2101
Fax Number	:	614-293-9155

Provider Business Practice Location Address
First Line	:	1581 DODD DR FL 1
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43210-1257
Country	:	US
Telephone Number	:	614-293-2101
Fax Number	:	614-293-9155

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

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	02/05/2024

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Directions to “ LARRY CHRISTOPHER MARTIN MD” Practice Location

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