Provider Demographics
NPI:1366440224
Name:MATTISON, LALAINE E (MD)
Entity Type:Individual
Prefix:
First Name:LALAINE
Middle Name:E
Last Name:MATTISON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7550 LUCERNE DR
Mailing Address - Street 2:STE 405
Mailing Address - City:MIDDLEBURG HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-6503
Mailing Address - Country:US
Mailing Address - Phone:440-234-8833
Mailing Address - Fax:440-234-3313
Practice Address - Street 1:5757 MONCLOVA RD
Practice Address - Street 2:STE 25
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-1863
Practice Address - Country:US
Practice Address - Phone:419-482-9761
Practice Address - Fax:419-794-8296
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2023-11-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35062263207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00146677OtherRAILROAD MEDICARE
OH02202OtherPARAMOUNT
OH000000345516OtherANTHEM
OH0258868Medicaid
OHG27307Medicare UPIN
OH02202OtherPARAMOUNT