Provider Demographics
NPI:1649262684
Name:MATYAS, JOHN A (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:MATYAS
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 1:5350 FRANTZ RD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-4259
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:500 THOMAS LN
Practice Address - Street 2:SUITE 2C
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3902
Practice Address - Country:US
Practice Address - Phone:614-566-2370
Practice Address - Fax:614-533-0436
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2013-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35042031208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0408651Medicaid
OHB86458Medicare UPIN
OHH005520Medicare PIN
OH0465632Medicare PIN