Provider Demographics
NPI:1972929313
Name:MATAR, ANWAR
Entity type:Individual
Prefix:MR
First Name:ANWAR
Middle Name:
Last Name:MATAR
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 1:300 E EXCHANGE ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44304-1760
Mailing Address - Country:US
Mailing Address - Phone:330-310-6142
Mailing Address - Fax:330-535-0339
Practice Address - Street 1:300 E EXCHANGE ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1760
Practice Address - Country:US
Practice Address - Phone:330-310-6142
Practice Address - Fax:330-535-0339
Is Sole Proprietor?:No
Enumeration Date:2014-03-10
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2500805Medicaid