Provider Demographics
NPI:1932943164
Name:MARTIN, ADAM JAMES
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:JAMES
Last Name:MARTIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:969 WILMINGTON AVE APT C
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45420-1655
Mailing Address - Country:US
Mailing Address - Phone:304-610-8633
Mailing Address - Fax:
Practice Address - Street 1:3533 SOUTHERN BLVD STE 2100
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-1267
Practice Address - Country:US
Practice Address - Phone:937-395-8556
Practice Address - Fax:937-395-6376
Is Sole Proprietor?:No
Enumeration Date:2024-06-21
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.009178RX363AS0400X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program