Provider Demographics
NPI:1124256656
Name:MARTIN, KENNETH W (CRNA)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:W
Last Name:MARTIN
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Gender:M
Credentials:CRNA
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Mailing Address - Street 1:2 CATHARINE STREET
Mailing Address - Street 2:MID-HUDSON ANESTHESIOLOGISTS, PC
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601
Mailing Address - Country:US
Mailing Address - Phone:845-790-2661
Mailing Address - Fax:845-790-2675
Practice Address - Street 1:70 DUBOIS STREET
Practice Address - Street 2:MID-HUDSON ANESTHESIOLOGISTS, PC
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550
Practice Address - Country:US
Practice Address - Phone:845-561-4400
Practice Address - Fax:308-254-7258
Is Sole Proprietor?:No
Enumeration Date:2009-06-23
Last Update Date:2020-03-09
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Provider Licenses
StateLicense IDTaxonomies
VA0024168356367500000X
NE101194367500000X
NY70552367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered