Provider Demographics
NPI:1437230554
Name:KANE, MATTHEW D (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:D
Last Name:KANE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 405984
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-5984
Mailing Address - Country:US
Mailing Address - Phone:304-235-2500
Mailing Address - Fax:304-235-0538
Practice Address - Street 1:859 ALDERSON ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSON
Practice Address - State:WV
Practice Address - Zip Code:25661-3215
Practice Address - Country:US
Practice Address - Phone:304-235-2500
Practice Address - Fax:304-235-0538
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK53042085R0202X
IL0360848662085R0202X
IN01041683A2085R0202X
LAMD11325R2085R0202X
MO1074912085R0202X
NM96-822085R0202X
OH350705102085R0202X
TXK14932085R0202X
WV186462085R0202X
WY6918A2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHG10312Medicare UPIN