Provider Demographics
NPI:1538146691
Name:KASSAN, MARTIN ALAN (MD)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:ALAN
Last Name:KASSAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1536 WINCHESTER AVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-7662
Mailing Address - Country:US
Mailing Address - Phone:606-326-9888
Mailing Address - Fax:606-324-0057
Practice Address - Street 1:1536 WINCHESTER AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7662
Practice Address - Country:US
Practice Address - Phone:606-326-9888
Practice Address - Fax:606-324-0057
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-29
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY36296208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64050578Medicaid
KY64050578Medicaid
E10635Medicare UPIN