Provider Demographics
NPI:1679954820
Name:MARTIN, ANDREW JEFFREY (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:JEFFREY
Last Name:MARTIN
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 1:95 ARCH ST STE 215
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44304-1467
Mailing Address - Country:US
Mailing Address - Phone:330-434-4145
Mailing Address - Fax:234-312-2364
Practice Address - Street 1:95 ARCH ST STE 215
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1467
Practice Address - Country:US
Practice Address - Phone:330-434-4145
Practice Address - Fax:234-312-2364
Is Sole Proprietor?:No
Enumeration Date:2015-06-13
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH35.1518092086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program