Healthcare Provider Details

I. General information

NPI: 1013763275
Provider Name (Legal Business Name): MATEUS TRINCONI CUNHA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2024
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date: 11/27/2024
Reactivation Date: 07/21/2025

III. Provider practice location address

460 W 10TH AVE
COLUMBUS OH
43210-1240
US

IV. Provider business mailing address

700 ACKERMAN RD STE 2120
COLUMBUS OH
43202-1559
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-5066
  • Fax: 614-293-9449
Mailing address:
  • Phone: 614-293-5066
  • Fax: 614-293-9449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number35.154736
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: