Healthcare Provider Details

I. General information

NPI: 1578943866
Provider Name (Legal Business Name): MATTHEW RYAN STILLWAGON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2015
Last Update Date: 07/06/2021
Certification Date: 07/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL DR STE 4200
ASHEVILLE NC
28801-4550
US

IV. Provider business mailing address

1 HOSPITAL DR STE 4200
ASHEVILLE NC
28801-4550
US

V. Phone/Fax

Practice location:
  • Phone: 828-213-1111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number2021-00686
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number2021-00686
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: