Provider Demographics
NPI:1033188933
Name:MATES, MATTHEW A (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:A
Last Name:MATES
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6900 PEARL ROAD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:MIDDLEBURG HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-3639
Mailing Address - Country:US
Mailing Address - Phone:440-845-0900
Mailing Address - Fax:440-845-7355
Practice Address - Street 1:6900 PEARL ROAD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:MIDDLEBURG HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-3639
Practice Address - Country:US
Practice Address - Phone:440-845-0900
Practice Address - Fax:440-845-7355
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50000676363A00000X
OH50.000676363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0117576Medicaid