DR. MATTHEW JACOB KOTLOVE (NPI# 1821416645) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1821416645 |
| Entity Type | Individual |
| Full Name | DR. MATTHEW JACOB KOTLOVE |
| Credential | MD |
| Practice Address |
20 Medical Village Dr Edgewood KY 41017-5401 |
| Mailing Address |
Po Box 636324 Cincinnati OH 45263-6324 |
| Practice Telephone | 8593014000 |
| Practice Fax Number | 8593014001 |
| Mailing Telephone | 8593445555 |
| Mailing Fax Number | 8593014001 |
| Enumeration Date | 2014-03-29 |
| Last Update Date | 2020-07-09 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207R00000X | Internal Medicine | 35.130665 | OH | Allopathic & Osteopathic Physicians |
| N | 207R00000X | Internal Medicine | 57.024319 | OH | Allopathic & Osteopathic Physicians |
| N | 207RH0003X |
Internal Medicine Specialization: Hematology & Oncology |
35.130665 | OH | Allopathic & Osteopathic Physicians |
| Y | 207RX0202X |
Internal Medicine Specialization: Medical Oncology |
54040 | KY | Allopathic & Osteopathic Physicians |
| Street Address |
20 MEDICAL VILLAGE DR |
| City | EDGEWOOD |
| State | KY |
| Zip Code | 41017-5401 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841295243 | Paul Allen Jacobs | Obstetrics & Gynecology | 20 Medical Village Dr, Ste 302, Edgewood, KY 41017-5402 | 2005-06-14 |
| 1043821085 | David Thomas Tackett | Nurse Practitioner | 20 Medical Village Dr, Edgewood, KY 41017-5401 | 2020-08-13 |
| 1245866888 | Annalee Fitzpatrick | Nurse Practitioner | 20 Medical Village Dr, Edgewood, KY 41017-5401 | 2020-03-16 |
| 1972137313 | Thomas Gravely | Pharmacist | 20 Medical Village Dr, Edgewood, KY 41017-5401 | 2020-02-25 |
| 1205487071 | Amanda M Hofmeyer | Nurse Practitioner | 20 Medical Village Dr, Edgewood, KY 41017-5401 | 2019-09-24 |
| 1528535804 | Heidi Ann Ducker | Nurse Practitioner | 20 Medical Village Dr, Edgewood, KY 41017-5401 | 2018-10-25 |
| 1316433014 | Tara Nagaraj | Pharmacist | 20 Medical Village Dr, Edgewood, KY 41017 | 2018-07-05 |
| 1033628268 | Jennifer Teresa Sprague | Physician Assistant | 20 Medical Village Dr, Edgewood, KY 41017-5401 | 2017-09-20 |
| 1235658857 | Eric Joseph Faris | Nurse Practitioner | 20 Medical Village Dr, Edgewood, KY 41017 | 2017-09-14 |
| 1356876940 | Jennifer Vaden | Registered Nurse | 20 Medical Village Dr, Suite 301, Edgewood, KY 41017-5401 | 2017-04-20 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578187209 | St. Elizabeth Medical Center, Inc. | Pharmacy | 1 Medical Village Dr., Edgewood, KY 41017 | 2020-05-28 |
| 1366084337 | St. Elizabeth Medical Center, Inc. | Pharmacy | 850 Thomas More Parkway, Edgewood, KY 41017 | 2019-10-11 |
| 1396396750 | Family First Vision Care Kentucky | Optometrist | 614 Buttermilk Pike, Fort Mitchell, KY 41017 | 2019-09-26 |
| 1083184543 | Katie Franconia Smith | Nurse Practitioner | 2865 Chancellor Dr., Crestview Hills, KY 41017 | 2018-11-27 |
| 1871077511 | Janet Reeves Martin | Nurse Practitioner | Infinity Dialysis, 4750 East Galbraith Rd. Suite 103, Cincinnati, OH 41017 | 2018-09-19 |
| 1144713983 | Kelly Wiechart | Dentist | 599 Freedom Park Dr Ste 100, Crestview Hills, KY 41017 | 2018-06-06 |
| 1225535966 | Proscan Radiology Northern Kentucky, LLC | Radiology | 350 Thomas More Pkwy Ste 170, Crestview Hills, KY 41017 | 2018-04-10 |
| 1396241626 | Tressa S. Leahy | Physical Therapist | 200 Medical Village Drive, Edgewood, KY 41017 | 2018-04-04 |
| 1699294470 | Raymond Gardinier | Physical Therapist | 3755 Old Ky 17, Fort Wright, KY 41017 | 2017-09-13 |
| 1992229785 | Adrienne Bussard | Physician Assistant | 334 Thomas More Pkwy Ste 120, Crestview Hills, KY 41017 | 2017-08-02 |
| Find all providers in zip 41017 | ||||
| Taxonomy Code | 207RX0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Medical Oncology |
| An internist who specializes in the diagnosis and treatment of all types of cancer and other benign and malignant tumors. This specialist decides on and administers therapy for these malignancies as well as consults with surgeons and radiotherapists on other treatments for cancer. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source. 11/5/2007: corrected definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679801435 | Peng Wang | Internal Medicine | 800 Rose St # Cc401b, Div of Medical Oncology, Lexington, KY 40536-0093 | 2009-12-04 |
| 1619112042 | Mohammed Aijaz Shareef | Internal Medicine | 2501 Kentucky Ave Ste 201, Paducah, KY 42003-3813 | 2008-12-15 |
| 1720176522 | Hematology Oncology Physicians East Kentucky Psc | Internal Medicine | 2737 North Laurel Road, London, KY 40741 | 2006-10-10 |
| 1326132457 | Ralph G. Zinner | Internal Medicine | Head, Neck and Respiratory Clinic, 800 Rose Street, 2nd Floor, Lexington, KY 40536-0293 | 2006-10-03 |
| 1184671166 | Richard Louis Gruenewald | Internal Medicine | 3638 Treehaven Bnd, Owensboro, KY 42303-1785 | 2006-05-27 |
| 1922520808 | 21st Century Oncology of Kentucky LLC | Internal Medicine | 1460 Bluegrass Ave, Louisville, KY 40215-1272 | 2017-07-12 |
| 1366715435 | Baptist Physicians Lexington, Inc | Internal Medicine | 1780 Nicholasville Rd, Suite 101, Lexington, KY 40503-1400 | 2012-02-20 |
| 1831462548 | Oncology Hematology Care, Inc. | Internal Medicine | 238 Barnes Rd, Williamstown, KY 41097-9482 | 2012-02-13 |
| 1932476330 | Saint Joseph Health System | Internal Medicine | 701 Bob O Link Dr, Ste 120, Lexington, KY 40504-3759 | 2011-11-30 |
| 1730490152 | Kamlesh Prem Sajnani | Internal Medicine | 37 Ball Park Rd, Harlan, KY 40831-1701 | 2010-06-30 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.