Provider Demographics
NPI:1841291507
Name:MCDONNELL, MATTHEW C (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:C
Last Name:MCDONNELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:970 EAST WASHINGTON STREET
Mailing Address - Street 2:SUITE 6A
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256
Mailing Address - Country:US
Mailing Address - Phone:330-723-6673
Mailing Address - Fax:330-764-9832
Practice Address - Street 1:970 EAST WASHINGTON STREET
Practice Address - Street 2:SUITE 6A
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256
Practice Address - Country:US
Practice Address - Phone:330-723-6673
Practice Address - Fax:330-764-9832
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35059577207Y00000X
OH35-05-9577207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0828886Medicaid
OHMC4038063Medicare PIN
OHE92009Medicare UPIN