MEDICARE: MATTHEW A PASSALACQUA DO

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	2085R0204X	Vascular & Interventional Radiology Physician	34005244P	OH
2	2085R0202X	Diagnostic Radiology Physician	34005244	OH
3	2085B0100X	Body Imaging Physician	34005244	OH
4	2085D0003X	Diagnostic Neuroimaging (Radiology) Physician	34005244	OH
5	2085U0001X	Diagnostic Ultrasound Physician	34005244	OH
6	2085H0002X	Hospice and Palliative Medicine (Radiology) Physician	34005244	OH
7	2085N0700X	Neuroradiology Physician	34005244	OH
8	2085N0904X	Nuclear Radiology Physician	34005244	OH
9	2085P0229X	Pediatric Radiology Physician	34005244	OH
10	2085R0001X	Radiation Oncology Physician	34005244	OH
11	2085R0203X	Therapeutic Radiology Physician	34005244	OH
12	207U00000X	Nuclear Medicine Physician	34005244	OH
13	207UN0903X	In Vivo & In Vitro Nuclear Medicine Physician	34005244	OH
14	207UN0901X	Nuclear Cardiology Physician	34005244	OH
15	207UN0902X	Nuclear Imaging & Therapy Physician	34005244	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00454367	OTHER	OH	RAILROAD MEDICARE
4	P00224514	OTHER	OH	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	421816	OTHER	OH	WELLCARE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	733909	OTHER	OH	BUCKEYE
6	000000550367	OTHER	OH	ANTHEM
7	000000364066	OTHER	OH	ANTHEM ID
8	0304914	OTHER	OH	BCMH
9	5261551	OTHER	OH	AETNA

General Provider Information

NPI Number	:	1639152457
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW A PASSALACQUA DO

Provider Business Mailing Address
First Line	:	24701 EUCLID AVE
Second Line	:	3RD FLOOR
City	:	EUCLID
State	:	OH
Zip	:	44117-1714
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11100 EUCLID AVENUE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44106
Country	:	US
Telephone Number	:	216-844-1700
Fax Number	:

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

Provider Enumeration Date	:	11/25/2005
Last Update Date	:	10/30/2013

Similar Medicare Providers

1760332449 — SONIA B KIM
Practice Location Address:

10900 EUCLID AVE
CLEVELAND, OH
44106-4901

Practice Phone: 216-368-2000
Practice Fax:

1215888664 — YINGXIN WU APRN.CNP
Practice Location Address:

11100 EUCLID AVE
CLEVELAND, OH
44106-1716

Practice Phone: 216-844-1000
Practice Fax:

1023826393 — TIFFANY E. CHAMBERS NP
Practice Location Address:

2460 FAIRMOUNT BLVD STE B
CLEVELAND HEIGHTS, OH
44106-3177

Practice Phone: 800-640-3451
Practice Fax:

1992656219 — GRACE HAVEN LIVING LLC
Practice Location Address:

1437 E 86TH ST
CLEVELAND, OH
44106-1015

Practice Phone: 216-616-7846
Practice Fax:

1922891902 — ANAMARIA BONILLA BLAKE CPNP-PC
Practice Location Address:

2101 ADELBERT RD
CLEVELAND, OH
44106-2624

Practice Phone: 216-286-5899
Practice Fax:

1356292635 — ADRIENNE D MASEK CNP
Practice Location Address:

10201 CARNEGIE AVE
CLEVELAND, OH
44106-2130

Practice Phone: 216-444-1712
Practice Fax:

1124762760 — TYLER JACOB GRUBB CAA
Practice Location Address:

11100 EUCLID AVE
CLEVELAND, OH
44106-1716

Practice Phone: 216-844-3722
Practice Fax:

Directions to “ MATTHEW A PASSALACQUA DO” 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.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.