Provider Demographics
NPI:1639664501
Name:GAFFNEY, MATTHEW RUSSELL
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:RUSSELL
Last Name:GAFFNEY
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 1:6507 HARRISON AVE UNIT N
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45247-2815
Mailing Address - Country:US
Mailing Address - Phone:513-981-4242
Mailing Address - Fax:513-347-5050
Practice Address - Street 1:6507 HARRISON AVE UNIT N
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45247-2815
Practice Address - Country:US
Practice Address - Phone:513-981-4242
Practice Address - Fax:513-347-5050
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-24
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.073310208000000X, 207R00000X
OH35.151292207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics