Healthcare Provider Details

I. General information

NPI: 1578654273
Provider Name (Legal Business Name): MATTHEW WILLIAM DAGGY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2449 ROSS MILLVILLE RD
HAMILTON OH
45013-8951
US

IV. Provider business mailing address

4685 FOREST AVE C
CINCINNATI OH
45212-3359
US

V. Phone/Fax

Practice location:
  • Phone: 513-856-5971
  • Fax:
Mailing address:
  • Phone: 513-853-4731
  • Fax: 513-852-8525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35088580
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number35-088580
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: