Healthcare Provider Details

I. General information

NPI: 1427092584
Provider Name (Legal Business Name): LEE ANNE MATTHEWS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 03/17/2023
Certification Date: 06/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 E STATE ST STE G110
ALLIANCE OH
44601-4380
US

IV. Provider business mailing address

PO BOX 80690
CANTON OH
44708-0690
US

V. Phone/Fax

Practice location:
  • Phone: 330-596-7895
  • Fax: 330-596-7891
Mailing address:
  • Phone: 330-363-7444
  • Fax: 330-363-7770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number35071507M
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License Number35071507
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: