Healthcare Provider Details

I. General information

NPI: 1578547642
Provider Name (Legal Business Name): MATTHEW R GALVIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 12/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 E 91ST ST SUITE C
INDIANAPOLIS IN
46240-1569
US

IV. Provider business mailing address

210 E 91ST ST SUITE C
INDIANAPOLIS IN
46240-1569
US

V. Phone/Fax

Practice location:
  • Phone: 317-844-0055
  • Fax: 317-571-5040
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number01028956A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number01028956A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: