Provider Demographics
NPI:1962405613
Name:MCQUAID, MATTHEW (DPM)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:MCQUAID
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5150 HILL RD E
Mailing Address - Street 2:STE A
Mailing Address - City:LAKEPORT
Mailing Address - State:CA
Mailing Address - Zip Code:95453-5100
Mailing Address - Country:US
Mailing Address - Phone:707-263-3727
Mailing Address - Fax:707-263-5236
Practice Address - Street 1:5150 HILL RD E
Practice Address - Street 2:STE A
Practice Address - City:LAKEPORT
Practice Address - State:CA
Practice Address - Zip Code:95453-5100
Practice Address - Country:US
Practice Address - Phone:707-263-3727
Practice Address - Fax:707-263-5236
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3998213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E39980Medicaid
CA480028899OtherRAIL ROAD
CAU52547Medicare UPIN
CA1296960001Medicare NSC
CA000E39980Medicare UPIN