Provider Demographics
NPI:1740600964
Name:DAPORE, MATT
Entity type:Individual
Prefix:MR
First Name:MATT
Middle Name:
Last Name:DAPORE
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 1:2968 JERICHO PL
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-3175
Mailing Address - Country:US
Mailing Address - Phone:614-401-7294
Mailing Address - Fax:
Practice Address - Street 1:203 BUCKEYE ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:OH
Practice Address - Zip Code:45882-9266
Practice Address - Country:US
Practice Address - Phone:419-363-2193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-28
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5096-2376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator