Provider Demographics
NPI:1487739157
Name:MATTEVI, PATRICIA (MD)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:MATTEVI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PATRIACIA
Other - Middle Name:A
Other - Last Name:MATTEVI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:7707 CHESTNUT RDG
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-8995
Mailing Address - Country:US
Mailing Address - Phone:419-868-1811
Mailing Address - Fax:
Practice Address - Street 1:2801 BAY PARK DR
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-4920
Practice Address - Country:US
Practice Address - Phone:419-690-7900
Practice Address - Fax:419-866-5453
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35066848207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0122325Medicaid
OH000000550247OtherANTHEM
OHMA4233741Medicare PIN
OH7309191Medicare ID - Type Unspecified
G04051Medicare UPIN
OH000000550247OtherANTHEM
MIMI1174015Medicare PIN