Provider Demographics
NPI:1104959584
Name:DAVID C MATTHEWS MD PA
Entity type:Organization
Organization Name:DAVID C MATTHEWS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-375-2955
Mailing Address - Street 1:1719 SOUTH BLVD
Mailing Address - Street 2:STE B
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-4727
Mailing Address - Country:US
Mailing Address - Phone:704-375-2955
Mailing Address - Fax:704-377-2766
Practice Address - Street 1:1719 SOUTH BLVD
Practice Address - Street 2:STE B
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-4727
Practice Address - Country:US
Practice Address - Phone:704-375-2955
Practice Address - Fax:704-377-2766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC54819OtherBCBS OF NC
NC8954819Medicaid
NC2346180Medicare PIN