Provider Demographics
NPI:1306096409
Name:MATT-AMARAL, LAURIE BETH (MD)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:BETH
Last Name:MATT-AMARAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:BETH
Other - Last Name:MATT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:224 W EXCHANGE ST
Mailing Address - Street 2:STE. 160
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44302-1704
Mailing Address - Country:US
Mailing Address - Phone:330-344-6505
Mailing Address - Fax:330-344-6431
Practice Address - Street 1:224 W EXCHANGE ST
Practice Address - Street 2:STE. 160
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44302-1704
Practice Address - Country:US
Practice Address - Phone:330-344-6505
Practice Address - Fax:330-344-6431
Is Sole Proprietor?:No
Enumeration Date:2008-09-24
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-096235207R00000X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9338635OtherPARTNERS PHYSICIAN GROUP MEDICARE #
OH3140489Medicaid
OH1841239274OtherPARTNERS PHYSICIAN GROUP TYPE 2 NPI #
OH2551671OtherPARTNERS PHYSICIAN GROUP MEDICAID #
OH3140489Medicaid
OH7426771Medicare PIN
OH3140489Medicaid
OH2551671OtherPARTNERS PHYSICIAN GROUP MEDICAID #