Healthcare Provider Details

I. General information

NPI: 1669405254
Provider Name (Legal Business Name): PREETI P MATKINS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 01/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3541 RANDOLPH RD SUITE 206
CHARLOTTE NC
28211-1253
US

IV. Provider business mailing address

PO BOX 601372
CHARLOTTE NC
28260-1372
US

V. Phone/Fax

Practice location:
  • Phone: 704-381-8336
  • Fax: 704-381-8332
Mailing address:
  • Phone: 704-381-8336
  • Fax: 704-381-8332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number9500136
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number9500136
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: