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

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