Provider Demographics
NPI:1104143528
Name:FUERST, MATTHEW DANIEL (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:DANIEL
Last Name:FUERST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:551 W CENTRAL AVE
Mailing Address - Street 2:SUITE NUMBER 301
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-1493
Mailing Address - Country:US
Mailing Address - Phone:740-615-1800
Mailing Address - Fax:
Practice Address - Street 1:551 W CENTRAL AVE
Practice Address - Street 2:SUITE NUMBER 301
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-1493
Practice Address - Country:US
Practice Address - Phone:740-615-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-24
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35099724207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0083565Medicaid
OHH209410Medicare PIN