Healthcare Provider Details

I. General information

NPI: 1508366915
Provider Name (Legal Business Name): MATTHEW D. MCFADDEN ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2018
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

291 KOLLMEYER ST
NEWPORT RI
02841-1605
US

IV. Provider business mailing address

291 KOLLMEYER ST
NEWPORT RI
02841-1605
US

V. Phone/Fax

Practice location:
  • Phone: 401-841-4553
  • Fax:
Mailing address:
  • Phone: 401-841-4553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT00389
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2000
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: