Provider Demographics
NPI:1740236249
Name:DEICH, MATTHEW S (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:S
Last Name:DEICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 102635
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-2635
Mailing Address - Country:US
Mailing Address - Phone:912-354-4800
Mailing Address - Fax:912-629-5821
Practice Address - Street 1:4720 WATERS AVE
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-6292
Practice Address - Country:US
Practice Address - Phone:912-354-4800
Practice Address - Fax:912-629-5821
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2017-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA047888207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP5020OtherSC MEDICAID- BLUFFTON
GA000843422FOtherMEDICAID- RINCON
GA000843422IOtherMEDICAID - STATESBORO
GA511G701032OtherGA MEDICARE GROUP
SCGPA977OtherSC MEDICAID
SCA18699143OtherSC MEDICARE
GA000843422GOtherMEDICAID - RICHMOND HILL
GA00843422AMedicaid
GA000843422HOtherMEDICAID - SAVANNAH
SC9143OtherSC MEDICARE GROUP
SCGPA977OtherSC MEDICAID
GA6150410004Medicare NSC
GA0412940004Medicare NSC
GA18BDFPVMedicare PIN
GA000843422FOtherMEDICAID- RINCON
SC9143OtherSC MEDICARE GROUP
GA6150410003Medicare NSC
GA000843422GOtherMEDICAID - RICHMOND HILL
GA000843422HOtherMEDICAID - SAVANNAH
GA6150410005Medicare NSC
SCGP5020OtherSC MEDICAID- BLUFFTON
GA0412940007Medicare NSC
GA180037484Medicare PIN
GA0412940002Medicare NSC