Provider Demographics
NPI:1558316190
Name:LOON, MARTIN H (MD)
Entity type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:H
Last Name:LOON
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 1:3407 CLIFTON AVE
Mailing Address - Street 2:SUITE 30
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45220-1763
Mailing Address - Country:US
Mailing Address - Phone:513-861-2490
Mailing Address - Fax:513-861-0148
Practice Address - Street 1:3217 CLIFTON AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45220-2418
Practice Address - Country:US
Practice Address - Phone:513-872-1400
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35044136L207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0473189Medicaid
OHLO0493771Medicare ID - Type Unspecified
OH0473189Medicaid