Provider Demographics
NPI:1194307827
Name:LAWS, MATTHEW GEORGE
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:GEORGE
Last Name:LAWS
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 1:44 W 14TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-2714
Mailing Address - Country:US
Mailing Address - Phone:703-930-5452
Mailing Address - Fax:
Practice Address - Street 1:1208 CLEVELAND RD W
Practice Address - Street 2:
Practice Address - City:HURON
Practice Address - State:OH
Practice Address - Zip Code:44839-1410
Practice Address - Country:US
Practice Address - Phone:703-646-3200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH36D2219898OtherCLIA