Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207L00000X | Anesthesiologist | 0101036233 | VA |
Y | 207L00000X | Anesthesiologist | 09592 | WV |
NPI | 1003827403 |
---|---|
Provider Name | Thomas Mathew |
First Address | Hamptonville, NC 27020-4038 |
Second Address | Hamptonville, NC 27020-7106 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2006 |
Last Update Date | 02/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
005738962 | (05) | VA |
0057893000 | (05) | WV |
D49522 | (02) | WV |