Provider Demographics
NPI:1487434973
Name:MARTIN, NATHAN RAY
Entity type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:RAY
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 1:1931 S GETTYSBURG AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45417-4160
Mailing Address - Country:US
Mailing Address - Phone:937-262-8876
Mailing Address - Fax:513-449-6528
Practice Address - Street 1:1931 S GETTYSBURG AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417-4160
Practice Address - Country:US
Practice Address - Phone:937-262-8876
Practice Address - Fax:513-449-6528
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.175755101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)