Healthcare Provider Details

I. General information

NPI: 1417143520
Provider Name (Legal Business Name): MATTHEW JOSEPH STONESTREET M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2007
Last Update Date: 06/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4760 BELPAR ST NW
CANTON OH
44718-3603
US

IV. Provider business mailing address

4760 BELPAR ST NW
CANTON OH
44718-3603
US

V. Phone/Fax

Practice location:
  • Phone: 330-492-9200
  • Fax: 330-492-5454
Mailing address:
  • Phone: 330-492-9200
  • Fax: 330-492-5454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number46014
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD448709
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number46014
License Number StateAZ
# 4
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number35122271
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: