MEDICARE: MATTHEW PAUL WAYT PA-C

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
1	363A00000X	Physician Assistant	2356	OH

General Provider Information

NPI Number	:	1427085844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW PAUL WAYT PA-C

Provider Business Mailing Address
First Line	:	245 LAKEWOOD DR
Second Line	:
City	:	ORRVILLE
State	:	OH
Zip	:	44667-1768
Country	:	US
Telephone Number	:	330-682-3075
Fax Number	:	330-682-7454

Provider Business Practice Location Address
First Line	:	365 S CROWN HILL RD
Second Line	:
City	:	ORRVILLE
State	:	OH
Zip	:	44667-9527
Country	:	US
Telephone Number	:	330-682-3075
Fax Number	:	330-682-7454

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	12/09/2013

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