Provider Demographics
NPI:1801960471
Name:MATTHEWS, LAUREL (MD)
Entity type:Individual
Prefix:
First Name:LAUREL
Middle Name:
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4471 BUCKEYE LN
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45440-3197
Mailing Address - Country:US
Mailing Address - Phone:216-225-4339
Mailing Address - Fax:440-550-8825
Practice Address - Street 1:4471 BUCKEYE LN
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45440-3197
Practice Address - Country:US
Practice Address - Phone:216-225-4339
Practice Address - Fax:440-550-8825
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35063400207P00000X, 2086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0979544Medicaid
OHE05636Medicare UPIN
OH4278403Medicare PIN
OHMA0894598Medicare PIN
OHH092560Medicare PIN