Provider Demographics
NPI:1114293420
Name:HITCHCOCK, MATTHEW MARVIN
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:MARVIN
Last Name:HITCHCOCK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 WOOD DUCK PL
Mailing Address - Street 2:APARTMENT 303
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-7299
Mailing Address - Country:US
Mailing Address - Phone:513-265-1976
Mailing Address - Fax:
Practice Address - Street 1:DUKE UNIVERSITY HOSPITAL
Practice Address - Street 2:2301 ERWIN ROAD
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710-0001
Practice Address - Country:US
Practice Address - Phone:919-684-8111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program