Provider Demographics
NPI:1003924622
Name:GOLDSCHMIDT, MATTHEW J (MD, DMD, FACS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:J
Last Name:GOLDSCHMIDT
Suffix:
Gender:M
Credentials:MD, DMD, FACS
Other - Prefix:DR
Other - First Name:MATTHEW
Other - Middle Name:J
Other - Last Name:GOLDSCHMIDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, DMD, FACS
Mailing Address - Street 1:220 NOB HILL OVAL
Mailing Address - Street 2:
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44022
Mailing Address - Country:US
Mailing Address - Phone:218-410-0618
Mailing Address - Fax:
Practice Address - Street 1:5005 ROCKSIDE RD
Practice Address - Street 2:SUITE 900
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-2194
Practice Address - Country:US
Practice Address - Phone:216-264-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-0830722086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery