Provider Demographics
NPI:1215970553
Name:DANGEL, MATTHEW EDWIN (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:EDWIN
Last Name:DANGEL
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 1:456 W 10TH AVE
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43210-1240
Mailing Address - Country:US
Mailing Address - Phone:614-293-0793
Mailing Address - Fax:614-293-5602
Practice Address - Street 1:456 W 10TH AVE
Practice Address - Street 2:5TH FLOOR
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1240
Practice Address - Country:US
Practice Address - Phone:614-293-0793
Practice Address - Fax:614-293-5602
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35042167207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0496333Medicaid
OHDA0483941Medicare ID - Type Unspecified
OH0496333Medicaid