Provider Demographics
NPI:1679797278
Name:RANSON, MATTHEW T (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:T
Last Name:RANSON
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 1:4838 E BASELINE RD STE 108
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4672
Mailing Address - Country:US
Mailing Address - Phone:480-724-7091
Mailing Address - Fax:480-854-1445
Practice Address - Street 1:4838 E BASELINE RD STE 108
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4672
Practice Address - Country:US
Practice Address - Phone:480-724-7091
Practice Address - Fax:480-854-1445
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ46448207LP2900X, 208VP0014X
WV23067207LP2900X, 208VP0000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2120967OtherOHIO JOB & FAMILY
WV3810012436Medicaid
WV9115180OtherAETNA
9296571Medicare PIN
9296571Medicare PIN
WV1679797278OtherPEIA
WV1679797278OtherSELECTNET
1679797278OtherCIGNA
OH$$$$$$$$$00OtherOHIO WORKERS COMP
WV1679797278Other4MOST
WV1679797278OtherBRICKSTREET
1679797278OtherHEALTHNET TRICARE
PENDINGOtherUS DOL
WV9115180OtherAETNA
WVPENDINGOtherCARELINK