Provider Demographics
NPI:1083827299
Name:GRAVITT, MARTIE JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:MARTIE
Middle Name:JOHN
Last Name:GRAVITT
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 W HIGH ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT GILEAD
Mailing Address - State:OH
Mailing Address - Zip Code:43338-1214
Mailing Address - Country:US
Mailing Address - Phone:419-751-7050
Mailing Address - Fax:740-513-4628
Practice Address - Street 1:169 W HIGH ST
Practice Address - Street 2:
Practice Address - City:MOUNT GILEAD
Practice Address - State:OH
Practice Address - Zip Code:43338-1214
Practice Address - Country:US
Practice Address - Phone:419-751-7050
Practice Address - Fax:740-513-4628
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.128787208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics