MEDICARE: MAHENDRA K MATTA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	35-04263	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1720085	OTHER	OH	UNITED HEALTHCARE
3	000000009386	OTHER	OH	ANTHEM PROVIDER
4	310983038	OTHER	OH	CIGNA PROVIDER
5	310983038	OTHER	OH	AETNA PROVIDER

General Provider Information

NPI Number	:	1518936814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAHENDRA K MATTA MD

Provider Business Mailing Address
First Line	:	10496 MONTGOMERY RD
Second Line	:	SUITE 204
City	:	CINCINNATI
State	:	OH
Zip	:	45242-5223
Country	:	US
Telephone Number	:	513-793-9835
Fax Number	:	513-793-9837

Provider Business Practice Location Address
First Line	:	10496 MONTGOMERY RD
Second Line	:	SUITE 204
City	:	CINCINNATI
State	:	OH
Zip	:	45242-5223
Country	:	US
Telephone Number	:	513-793-9835
Fax Number	:	513-793-9837

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/17/2006
Last Update Date	:	01/07/2015

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