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1508845207

NPI Code Detail

MEDICARE: MATTHEW STEVENSON WAYNE MD

MEDICARE: MATTHEW STEVENSON WAYNE MD

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	207R00000X	Internal Medicine Physician	35-069734	OH
2	207QG0300X	Geriatric Medicine (Family Medicine) Physician	35-069734	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00402008	OTHER	OH	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	414697	OTHER	OH	WELLCARE
4	000000524532	OTHER	OH	ANTHEM
5	751025	OTHER	OH	BUCKEYE
6	000000221142	OTHER	OH	UNISON
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	5496574	OTHER	OH	AETNA

General Provider Information

NPI Number	:	1508845207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW STEVENSON WAYNE MD

Provider Business Mailing Address
First Line	:	21076 BYRON RD
Second Line	:
City	:	SHAKER HTS
State	:	OH
Zip	:	44122-2915
Country	:	US
Telephone Number	:	216-844-6338
Fax Number	:	216-844-6338

Provider Business Practice Location Address
First Line	:	12200 FAIRHILL RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44120-1058
Country	:	US
Telephone Number	:	216-844-6300
Fax Number	:

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

Provider Enumeration Date	:	01/11/2006
Last Update Date	:	12/05/2008

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Directions to “ MATTHEW STEVENSON WAYNE MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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