Provider Demographics
NPI:1306048384
Name:CLEMENTS, MARTIN JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:JOSEPH
Last Name:CLEMENTS
Suffix:
Gender:M
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:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-301-2440
Mailing Address - Fax:859-301-2493
Practice Address - Street 1:1 MEDICAL VILLAGE DR
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017
Practice Address - Country:US
Practice Address - Phone:859-301-2440
Practice Address - Fax:859-301-2493
Is Sole Proprietor?:No
Enumeration Date:2007-06-03
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY40868207Q00000X, 207V00000X
WAMD00049231207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0083643Medicaid
WA8511248Medicaid
IN201178670Medicaid
KY7100029610Medicaid
IN201178670Medicaid
KY7100029610Medicaid
WA8511248Medicaid