Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 0101049424 | VA |
Y | 2080P0208X | Pediatric Infectious Diseases | 0101049424 | VA |
NPI | 1144275462 |
---|---|
Provider Name | David O. Matson |
First Address | Baltimore, MD 21279-0137 |
Second Address | Norfolk, VA 23507-1910 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2006 |
Last Update Date | 16/12/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010165423 | (05) | VA |
890523U | (05) | NC |
E77009 | (02) |