Healthcare Provider Details

I. General information

NPI: 1336126101
Provider Name (Legal Business Name): MARK ALLEN MATTHEWS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5147 MANCHESTER RD
AKRON OH
44319-3911
US

IV. Provider business mailing address

5147 MANCHESTER RD
AKRON OH
44319-3911
US

V. Phone/Fax

Practice location:
  • Phone: 330-644-3747
  • Fax: 330-644-9815
Mailing address:
  • Phone: 330-644-3747
  • Fax: 330-644-9815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35060104
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: