MEDICARE: MR. HARRY MARQUETTE MATTHEWS P.A.

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
1	363AM0700X	Medical Physician Assistant	100071	NC

General Provider Information

NPI Number	:	1376579136
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. HARRY MARQUETTE MATTHEWS P.A.

Provider Business Mailing Address
First Line	:	804 ENGLISH RD
Second Line	:
City	:	ROCKY MOUNT
State	:	NC
Zip	:	27804-6023
Country	:	US
Telephone Number	:	252-937-4100
Fax Number	:	252-937-4103

Provider Business Practice Location Address
First Line	:	804 ENGLISH RD
Second Line	:
City	:	ROCKY MOUNT
State	:	NC
Zip	:	27804-6023
Country	:	US
Telephone Number	:	252-937-4100
Fax Number	:	252-937-4103

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2006
Last Update Date	:	07/08/2007

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