Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 0101267112 | VA |
NPI | 1043536717 |
---|---|
Provider Name | Dr. Matthew Jonathon Stotts |
First Address | Charlottesville, VA 22906-9007 |
Second Address | Charlottesville, VA 22908-0816 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2010 |
Last Update Date | 02/08/2021 |