Provider Demographics
NPI:1942569041
Name:KNECHT, MATTHEW LEE
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:LEE
Last Name:KNECHT
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 1:3700 SOUTHERN BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-1226
Mailing Address - Country:US
Mailing Address - Phone:937-281-3810
Mailing Address - Fax:937-281-3812
Practice Address - Street 1:3525 PENTAGON BLVD
Practice Address - Street 2:STE 101
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45431-1705
Practice Address - Country:US
Practice Address - Phone:937-702-4060
Practice Address - Fax:937-702-4069
Is Sole Proprietor?:No
Enumeration Date:2012-05-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.1305272085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0226528Medicaid