Healthcare Provider Details

I. General information

NPI: 1245461128
Provider Name (Legal Business Name): MATHEWS KEECHERIL PHILIP MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2009
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 PINEYWOOD RD
THOMASVILLE NC
27360-3438
US

IV. Provider business mailing address

PO BOX 751803
CHARLOTTE NC
28275-1803
US

V. Phone/Fax

Practice location:
  • Phone: 336-475-8121
  • Fax: 336-475-5377
Mailing address:
  • Phone: 704-316-5060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2013-00865
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: