Healthcare Provider Details

I. General information

NPI: 1891906459
Provider Name (Legal Business Name): GINA MATACIA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5520 CHEVIOT RD
CINCINNATI OH
45247-7069
US

IV. Provider business mailing address

5520 CHEVIOT RD
CINCINNATI OH
45247-7069
US

V. Phone/Fax

Practice location:
  • Phone: 513-451-4033
  • Fax: 513-451-4118
Mailing address:
  • Phone: 513-451-4033
  • Fax: 513-451-4118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number35-093919
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number35-093919
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: