Provider Demographics
NPI:1194809558
Name:MATTHEW, ANDREW M (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:M
Last Name:MATTHEW
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 1:29355 CASTLEHILL DR
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-4432
Mailing Address - Country:US
Mailing Address - Phone:818-889-9141
Mailing Address - Fax:
Practice Address - Street 1:358 KANAN RD
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:CA
Practice Address - Zip Code:91377-1111
Practice Address - Country:US
Practice Address - Phone:818-707-0046
Practice Address - Fax:818-707-2430
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG35714208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ475082Medicare UPIN