Provider Demographics
NPI:1164919973
Name:EDINGTON, MATTHEW E (DPM)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:E
Last Name:EDINGTON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4503 FULTON DR NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2331
Mailing Address - Country:US
Mailing Address - Phone:330-956-4857
Mailing Address - Fax:330-956-4912
Practice Address - Street 1:4503 FULTON DR NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2331
Practice Address - Country:US
Practice Address - Phone:330-956-4857
Practice Address - Fax:330-956-4912
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-17
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH36.004025213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program