Healthcare Provider Details

I. General information

NPI: 1194300277
Provider Name (Legal Business Name): MATTHEW WINSTON MOY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2021
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 HYDE ST
WAKEMAN OH
44889-9301
US

IV. Provider business mailing address

11072 BARRINGTON BLVD
PARMA HEIGHTS OH
44130-4411
US

V. Phone/Fax

Practice location:
  • Phone: 440-839-2226
  • Fax:
Mailing address:
  • Phone: 347-612-8090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.149040
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number35.149040
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: