Basic Information
| Provider Information | |||||||||
| NPI: | 1134105372 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MATADAR | ||||||||
| FirstName: | AKBAR | ||||||||
| MiddleName: | GULAMMOHAMED | ||||||||
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| Credential: | MD FACS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 380 SUMMIT AVE | ||||||||
| Address2: | |||||||||
| City: | STEUBENVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 439522667 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7402837597 | ||||||||
| FaxNumber: | 7402837807 | ||||||||
| Practice Location | |||||||||
| Address1: | 41199 YAKEY LN | ||||||||
| Address2: | |||||||||
| City: | LOVETTSVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201802401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4127087240 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/20/2005 | ||||||||
| LastUpdateDate: | 12/09/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/09/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | 10680 | WV | N | Allopathic & Osteopathic Physicians | Otolaryngology | 207Y00000X | MD 017518E | PA | N | Allopathic & Osteopathic Physicians | Otolaryngology | 207Y00000X | 35 03 9470 | OH | N | Allopathic & Osteopathic Physicians | Otolaryngology | 207Y00000X | 0101266792 | VA | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | P00695984 | 01 | OH | RR MEDICARE | OTHER | P01020743 | 01 | OH | RR MEDICARE | OTHER | 001705974 | 01 | MOUNTAIN STATE BC BS | OTHER | 0598454 | 01 | MEDICARE | OTHER | 000000113358 | 01 | ANTHEM | OTHER | 220876 | 01 | CARELINK | OTHER | 35183 | 01 | COVENTRY | OTHER | 0295256 | 05 | OH | MEDICAID |