Provider Demographics
NPI:1881007706
Name:GOOCH, MATTHEW S (CNP)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:S
Last Name:GOOCH
Suffix:
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1207 W STATE ST
Mailing Address - Street 2:SUITE N
Mailing Address - City:ALLIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:44601-4686
Mailing Address - Country:US
Mailing Address - Phone:330-821-3244
Mailing Address - Fax:330-680-4110
Practice Address - Street 1:1207 W STATE ST
Practice Address - Street 2:SUITE N
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-4686
Practice Address - Country:US
Practice Address - Phone:330-821-3244
Practice Address - Fax:330-680-4110
Is Sole Proprietor?:No
Enumeration Date:2014-06-09
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH15946-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0105804Medicaid
OH0105804Medicaid