Provider Demographics
NPI:1871828863
Name:OLSON, DAVID MATTHEW (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:MATTHEW
Last Name:OLSON
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 1:1700 BOETTLER RD
Mailing Address - Street 2:STE. 100
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685-7792
Mailing Address - Country:US
Mailing Address - Phone:330-896-0009
Mailing Address - Fax:330-896-0032
Practice Address - Street 1:855 W MAPLE ST STE 110
Practice Address - Street 2:
Practice Address - City:HARTVILLE
Practice Address - State:OH
Practice Address - Zip Code:44632-7601
Practice Address - Country:US
Practice Address - Phone:330-877-3616
Practice Address - Fax:330-877-1783
Is Sole Proprietor?:No
Enumeration Date:2009-10-08
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH58-003267390200000X
OH34010510207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH098390Medicare PIN