MEDICARE: DR. MATTHEW DACUNHA 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	390200000X	Student in an Organized Health Care Education/Training Program
2	207N00000X	Dermatology Physician	R-11726	IA
3	207N00000X	Dermatology Physician	35.147217	OH

General Provider Information

NPI Number	:	1659833622
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW DACUNHA MD

Provider Business Mailing Address
First Line	:	3024 BURNET AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45219-2420
Country	:	US
Telephone Number	:	513-221-2828
Fax Number	:	513-872-5721

Provider Business Practice Location Address
First Line	:	3024 BURNET AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45219-2420
Country	:	US
Telephone Number	:	513-221-2828
Fax Number	:	513-872-5721

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

Provider Enumeration Date	:	04/01/2019
Last Update Date	:	05/30/2023

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