Provider Demographics
NPI:1386960870
Name:PAINTING, MATTHEW DAVID (DPM)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:DAVID
Last Name:PAINTING
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 WEST RUSS ROAD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45331
Mailing Address - Country:US
Mailing Address - Phone:937-548-1244
Mailing Address - Fax:937-548-8898
Practice Address - Street 1:415 WEST RUSS ROAD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:OH
Practice Address - Zip Code:45331
Practice Address - Country:US
Practice Address - Phone:937-548-1244
Practice Address - Fax:937-548-8898
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-09
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003537213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH36003537OtherOHIO STATE MEDICAL LICENSE