Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 63818 | TN |
NPI | 1104243088 |
---|---|
Provider Name | Matthew Richey |
First Address | Chattanooga, TN 37404-1127 |
Second Address | Chattanooga, TN 37404-1161 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2014 |
Last Update Date | 11/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
63818 | TN MD LICENSE (01) | TN |