Healthcare Provider Details

I. General information

NPI: 1740210806
Provider Name (Legal Business Name): MATTHEW J MINGIONE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 01/05/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 OLENTANGY RIVER RD STE. 3030
COLUMBUS OH
43214-3912
US

IV. Provider business mailing address

1299 OLENTANGY RIVER RD STE. 103
COLUMBUS OH
43212-3118
US

V. Phone/Fax

Practice location:
  • Phone: 614-566-4378
  • Fax: 614-566-6904
Mailing address:
  • Phone: 614-566-4278
  • Fax: 614-566-5424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number35089313
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: