Healthcare Provider Details

I. General information

NPI: 1386677946
Provider Name (Legal Business Name): MATTHEW MARCOTTE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MATTHEW MARCOTTE D.C.

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 09/27/2021
Certification Date: 07/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8611 COLUMBUS PIKE
LEWIS CENTER OH
43035-9614
US

IV. Provider business mailing address

8611 COLUMBUS PIKE
LEWIS CENTER OH
43035-9614
US

V. Phone/Fax

Practice location:
  • Phone: 614-839-1044
  • Fax: 740-879-2813
Mailing address:
  • Phone: 614-839-1044
  • Fax: 740-879-2813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.002737RX
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3745
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number041340
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number3745
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: