Provider Demographics
NPI:1134105372
Name:MATADAR, AKBAR GULAMMOHAMED (MD FACS)
Entity Type:Individual
Prefix:
First Name:AKBAR
Middle Name:GULAMMOHAMED
Last Name:MATADAR
Suffix:
Gender:M
Credentials:MD FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43952-2667
Mailing Address - Country:US
Mailing Address - Phone:740-283-7597
Mailing Address - Fax:740-283-7807
Practice Address - Street 1:41199 YAKEY LN
Practice Address - Street 2:
Practice Address - City:LOVETTSVILLE
Practice Address - State:VA
Practice Address - Zip Code:20180-2401
Practice Address - Country:US
Practice Address - Phone:412-708-7240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV10680207Y00000X
PAMD 017518E207Y00000X
OH35 03 9470207Y00000X
VA0101266792207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00695984OtherRR MEDICARE
OHP01020743OtherRR MEDICARE
001705974OtherMOUNTAIN STATE BC BS
0598454OtherMEDICARE
000000113358OtherANTHEM
220876OtherCARELINK
35183OtherCOVENTRY
OH0295256Medicaid
000000113358OtherANTHEM
OHP00695984OtherRR MEDICARE
OHP01020743OtherRR MEDICARE
OHH52130Medicare PIN
PA153249PK7Medicare PIN
0598454OtherMEDICARE