Healthcare Provider Details

I. General information

NPI: 1437501863
Provider Name (Legal Business Name): MATRONE PRIMARY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2016
Last Update Date: 09/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2412 WINDSOR TRL
RALEIGH NC
27615-1200
US

IV. Provider business mailing address

2412 WINDSOR TRL
RALEIGH NC
27615-1200
US

V. Phone/Fax

Practice location:
  • Phone: 919-410-3734
  • Fax: 984-242-4502
Mailing address:
  • Phone: 919-410-3734
  • Fax: 984-242-4502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number5006048
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number500048
License Number StateNC

VIII. Authorized Official

Name: MR. ANDREW K MATRONE
Title or Position: CEO
Credential: ANP
Phone: 919-410-3734