Healthcare Provider Details

I. General information

NPI: 1588292403
Provider Name (Legal Business Name): MATTHEW S LYMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2020
Last Update Date: 01/25/2024
Certification Date: 01/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1023 S MAIN ST STE 200
CENTERVILLE OH
45458-4358
US

IV. Provider business mailing address

2145 N FAIRFIELD RD STE 100
BEAVERCREEK OH
45431-2783
US

V. Phone/Fax

Practice location:
  • Phone: 937-436-3117
  • Fax: 937-436-0730
Mailing address:
  • Phone: 937-558-3900
  • Fax: 937-558-3999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.143811
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: