Healthcare Provider Details

I. General information

NPI: 1215677232
Provider Name (Legal Business Name): MATTHEW MARTIN SCHOLL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2022
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 EVELYN AVE STE 115
ALBANY CA
94706-1350
US

IV. Provider business mailing address

400 EVELYN AVE STE 115
ALBANY CA
94706-1350
US

V. Phone/Fax

Practice location:
  • Phone: 510-524-0224
  • Fax: 510-524-0215
Mailing address:
  • Phone: 510-524-0224
  • Fax: 510-524-0215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA207667
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberV4743
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: