Provider Demographics
NPI:1912006396
Name:BARILLE, MATTHEW SLADE
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:SLADE
Last Name:BARILLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6305 FAIRHAVEN RD
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-4110
Mailing Address - Country:US
Mailing Address - Phone:440-473-2138
Mailing Address - Fax:
Practice Address - Street 1:6318 EASTONDALE RD
Practice Address - Street 2:
Practice Address - City:MAYFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44124-4105
Practice Address - Country:US
Practice Address - Phone:440-449-5682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2459996251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2459996Medicare UPIN