Provider Demographics
NPI:1891561163
Name:MATTHEWS, GREGORY PATRICK (PRSS)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:PATRICK
Last Name:MATTHEWS
Suffix:
Gender:M
Credentials:PRSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 ADA DR
Mailing Address - Street 2:
Mailing Address - City:NEW MARTINSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26155-2800
Mailing Address - Country:US
Mailing Address - Phone:304-771-2082
Mailing Address - Fax:
Practice Address - Street 1:3 ADA DR
Practice Address - Street 2:
Practice Address - City:NEW MARTINSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26155-2800
Practice Address - Country:US
Practice Address - Phone:304-771-2082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-28
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist