Provider Demographics
NPI:1487723169
Name:PARSONS, MATTHEW LORING (PA-C)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:LORING
Last Name:PARSONS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 POPLAR ST
Mailing Address - Street 2:SUITE 303
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25309-1474
Mailing Address - Country:US
Mailing Address - Phone:304-766-7374
Mailing Address - Fax:304-766-9690
Practice Address - Street 1:500 POPLAR ST
Practice Address - Street 2:SUITE 303
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-1474
Practice Address - Country:US
Practice Address - Phone:304-766-7374
Practice Address - Fax:304-766-9690
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV01173363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0098202000Medicaid
WVQ55439Medicare UPIN
WV9335711Medicare ID - Type Unspecified