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NPI Code Detail

MEDICARE: MARK ALLEN MATTHEWS M.D.

MEDICARE: MARK ALLEN MATTHEWS M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician35060104OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1336126101
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK ALLEN MATTHEWS M.D.
Provider Business Mailing Address
First Line : 5147 MANCHESTER RD
Second Line :
City : AKRON
State : OH
Zip : 44319-3911
Country : US
Telephone Number : 330-644-3747
Fax Number : 330-644-9815
Provider Business Practice Location Address
First Line : 5147 MANCHESTER RD
Second Line :
City : AKRON
State : OH
Zip : 44319-3911
Country : US
Telephone Number : 330-644-3747
Fax Number : 330-644-9815
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/22/2005
Last Update Date : 07/08/2007

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