Healthcare Provider Details

I. General information

NPI: 1811597586
Provider Name (Legal Business Name): MARY KATHLEEN MATTHEWS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATHLEEN MATTHEWS MD

II. Dates (important events)

Enumeration Date: 10/30/2020
Last Update Date: 10/30/2020
Certification Date: 10/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2030 CLERMONT ST
DENVER CO
80207-3738
US

IV. Provider business mailing address

1305 KRAMERIA ST # H145
DENVER CO
80220-2743
US

V. Phone/Fax

Practice location:
  • Phone: 303-377-6724
  • Fax:
Mailing address:
  • Phone: 303-377-6724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number26675
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: