Provider Demographics
NPI:1356323000
Name:COSENZA, MATHEW J (DO)
Entity Type:Individual
Prefix:
First Name:MATHEW
Middle Name:J
Last Name:COSENZA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 JACKSON PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1560
Mailing Address - Country:US
Mailing Address - Phone:740-446-5418
Mailing Address - Fax:740-446-5958
Practice Address - Street 1:280 PATTONSVILLE RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:OH
Practice Address - Zip Code:45640-9452
Practice Address - Country:US
Practice Address - Phone:855-446-5937
Practice Address - Fax:740-395-8834
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34006288207YS0123X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000260440OtherANTHEM BLUE CROSS
7664166OtherAETNA
OH2211949OtherRAILROAD MEDICARE
8949866OtherCIGNA
OH2211949Medicaid
7664166OtherAETNA
H26892Medicare UPIN
8949866OtherCIGNA