Provider Demographics
NPI:1013159433
Name:MAURICE, MATTHEW JOSEPH (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:JOSEPH
Last Name:MAURICE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 TUSCARAWAS ST W STE 400
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-4698
Mailing Address - Country:US
Mailing Address - Phone:330-458-2000
Mailing Address - Fax:330-458-2010
Practice Address - Street 1:2600 TUSCARAWAS ST W STE 400
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-4698
Practice Address - Country:US
Practice Address - Phone:330-458-2000
Practice Address - Fax:330-458-2010
Is Sole Proprietor?:No
Enumeration Date:2009-03-31
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH390200000X
OH125952208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program