Provider Demographics
NPI:1124091889
Name:MATTHEWS, DAVID C (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:C
Last Name:MATTHEWS
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 1:1719 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-10
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26565174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8954819Medicaid
NCC85359Medicare UPIN
NC8954819Medicaid