Healthcare Provider Details

I. General information

NPI: 1003827403
Provider Name (Legal Business Name): THOMAS MATHEW M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 08/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2730 ARNOLD RD
HAMPTONVILLE NC
27020-7106
US

IV. Provider business mailing address

2730 ARNOLD RD SUITE 2
HAMPTONVILLE NC
27020-4038
US

V. Phone/Fax

Practice location:
  • Phone: 336-469-1642
  • Fax:
Mailing address:
  • Phone: 336-468-1642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number09592
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number0101036233
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: