Provider Demographics
NPI:1801845524
Name:CHENG, MATTHEW (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:CHENG
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 1:8423 MARKET ST.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-6778
Mailing Address - Country:US
Mailing Address - Phone:330-707-5864
Mailing Address - Fax:330-707-2210
Practice Address - Street 1:2094 E. STATE ST.
Practice Address - Street 2:SUITE G
Practice Address - City:SALEM
Practice Address - State:OH
Practice Address - Zip Code:44460-9998
Practice Address - Country:US
Practice Address - Phone:330-337-0177
Practice Address - Fax:330-337-0178
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35092716207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH020567610OtherFEDERAL BLACK LUNG
OH000000600306OtherANTHEM BLUE CROSS/BLUE SHIELD
OH020567610OtherCOMMERCIAL
OH020567610LOtherAULTCARE
OH2907420Medicaid
OH2907420Medicaid
OH4260232Medicare PIN
CJ6989Medicare ID - Type UnspecifiedRAIL ROAD MEDICARE
OH4260233Medicare PIN
OH4260231Medicare PIN