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NPI Code Detail

MEDICARE: MATTHEW COLVIN PA-C

MEDICARE: MATTHEW COLVIN PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantTC335KY
2363A00000XPhysician Assistant50.004729RXOH
3363A00000XPhysician Assistant704WV

General Provider Information

NPI Number : 1023413226
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATTHEW COLVIN PA-C
Provider Business Mailing Address
First Line : PO BOX 390
Second Line :
City : HUNTINGTON
State : WV
Zip : 25708-0390
Country : US
Telephone Number : 304-429-1088
Fax Number : 304-429-3109
Provider Business Practice Location Address
First Line : 705 WASHINGTON ST
Second Line :
City : RAVENSWOOD
State : WV
Zip : 26164-1729
Country : US
Telephone Number : 304-868-8000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/30/2014
Last Update Date : 11/23/2020

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Directions to “ MATTHEW COLVIN PA-C” Practice Location

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