Healthcare Provider Details

I. General information

NPI: 1992455604
Provider Name (Legal Business Name): MATTHEW JAMES MICHAEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2022
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 TOWSON AVE
FORT SMITH AR
72901-4921
US

IV. Provider business mailing address

1900 ELECTRIC RD
SALEM VA
24153-7474
US

V. Phone/Fax

Practice location:
  • Phone: 917-242-5733
  • Fax:
Mailing address:
  • Phone: 540-776-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberE-20861
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: