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NPI Code Detail

MEDICARE: DR. MATTHEW R NOORDSIJ-JONES MD

MEDICARE: DR. MATTHEW R NOORDSIJ-JONES 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
1207R00000XInternal Medicine Physician57.012055OH
2208000000XPediatrics Physician57.012055OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1891911640
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MATTHEW R NOORDSIJ-JONES MD
Provider Business Mailing Address
First Line : 1323 W 3RD ST
Second Line :
City : DAYTON
State : OH
Zip : 45402-6714
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2351 STANLEY AVE
Second Line :
City : DAYTON
State : OH
Zip : 45404-1201
Country : US
Telephone Number : 937-228-0990
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/18/2007
Last Update Date : 06/30/2014

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