Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 0101259546 | VA |
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 0101259546 | VA |
NPI | 1457396913 |
---|---|
Provider Name | Victoria Matt |
First Address | Richmond, VA 23255-1690 |
Second Address | Richmond, VA 23226-2553 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2006 |
Last Update Date | 15/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03050882 | (05) | NM |
I41965 | (02) | AK |
MD2359 | (05) | AK |