Provider Demographics
NPI:1770568545
Name:HESS, MATTHEW D (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:D
Last Name:HESS
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 1:11109 PARKVIEW PLAZA DR # 117
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1701
Mailing Address - Country:US
Mailing Address - Phone:260-266-8210
Mailing Address - Fax:
Practice Address - Street 1:1818 CAREW ST STE 240
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-4764
Practice Address - Country:US
Practice Address - Phone:260-373-9565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01058083A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN17807OtherPHYSICIANS HEALTH PLAN
IN200521180Medicaid
IN3937240015OtherMEDICARE DMEPOS
IN000000370499OtherANTHEM
INP00323505OtherRAILROAD MEDICARE
7594561OtherAETNA
IN070900PMedicare PIN
INP00323505OtherRAILROAD MEDICARE
I06271Medicare UPIN
IN070820FMedicare PIN
IN200521180Medicaid
IN135920XMedicare PIN
IN070830RMedicare PIN
IN069880KMedicare PIN