Healthcare Provider Details

I. General information

NPI: 1629034681
Provider Name (Legal Business Name): MATTHEW LAWLESS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 04/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 MIAMI VALLEY DR SUITE 320A
DAYTON OH
45459-4778
US

IV. Provider business mailing address

2350 MIAMI VALLEY DR SUITE 320A
DAYTON OH
45459-4778
US

V. Phone/Fax

Practice location:
  • Phone: 937-312-1661
  • Fax: 937-312-1701
Mailing address:
  • Phone: 937-312-1661
  • Fax: 937-312-1701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number35071585
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: