Provider Demographics
NPI:1992298616
Name:MARTIN, STEPHEN R (DO)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:R
Last Name:MARTIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1932 NILES CORTLAND RD NE STE P
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-1055
Mailing Address - Country:US
Mailing Address - Phone:330-856-7702
Mailing Address - Fax:330-856-1096
Practice Address - Street 1:1932 NILES CORTLAND RD NE STE P
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-1055
Practice Address - Country:US
Practice Address - Phone:330-856-7702
Practice Address - Fax:330-856-1096
Is Sole Proprietor?:No
Enumeration Date:2018-06-07
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.015513207Q00000X
PAOT018473208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine