Healthcare Provider Details

I. General information

NPI: 1871827915
Provider Name (Legal Business Name): MATTHEW DANIEL HASTINGS PA - C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2009
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E MAIN ST
NEW ALBANY OH
43054-9143
US

IV. Provider business mailing address

110 E MAIN ST
NEW ALBANY OH
43054-9143
US

V. Phone/Fax

Practice location:
  • Phone: 844-934-7546
  • Fax:
Mailing address:
  • Phone: 844-934-7546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA053829
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: