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General NPI Number Information
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NPI Number | 1356323000
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Entity Type | Individual
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Provider Name | MATHEW J COSENZA DO
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Gender | Male
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Dates
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Enumeration Date | 11/17/2005
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Last Update Date | 01/21/2021
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Provider Practice Location Address
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Address Line | 280 PATTONSVILLE RD
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City | JACKSON
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State | OH
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Zip | 45640-9452
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Country | US
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Telephone | 855-446-5937
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Fax | 740-395-8834
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Provider Business Mailing Address
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Address Line | 90 JACKSON PIKE
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City | GALLIPOLIS
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State | OH
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Zip | 45631-1560
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Country | US
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Telephone | 740-446-5418
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Fax | 740-446-5958
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YS0123X
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Taxonomy Name | Facial Plastic Surgery Physician
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License Number | 34006288
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 34006288
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License Number State | OH
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