Provider Demographics
NPI:1932504222
Name:DORER, MATTHEW (PA-C, AT)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:DORER
Suffix:
Gender:M
Credentials:PA-C, AT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2713 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44134-1923
Mailing Address - Country:US
Mailing Address - Phone:216-313-1712
Mailing Address - Fax:
Practice Address - Street 1:2713 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44134-1923
Practice Address - Country:US
Practice Address - Phone:216-313-1712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-29
Last Update Date:2025-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT0051192255A2300X
OHAPP-001012951363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer