Provider Demographics
NPI:1427657667
Name:ATLANTIC INTERNAL MEDICINE
Entity type:Organization
Organization Name:ATLANTIC INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPERITOR
Authorized Official - Prefix:
Authorized Official - First Name:RAMON
Authorized Official - Middle Name:
Authorized Official - Last Name:MATAWARAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-915-8691
Mailing Address - Street 1:171 KEMPSVILLE RD BLDG A
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-4700
Mailing Address - Country:US
Mailing Address - Phone:757-975-4695
Mailing Address - Fax:757-852-0699
Practice Address - Street 1:171 KEMPSVILLE RD BLDG A
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-4700
Practice Address - Country:US
Practice Address - Phone:757-975-4695
Practice Address - Fax:757-852-0699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-20
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty