Healthcare Provider Details

I. General information

NPI: 1477422905
Provider Name (Legal Business Name): MATTHEW BRINSON ZYDRON CPO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2025
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4057 TAYLOR RD STE P
CHESAPEAKE VA
23321-5527
US

IV. Provider business mailing address

9000 FERRY POINT RD
SUFFOLK VA
23432-1501
US

V. Phone/Fax

Practice location:
  • Phone: 757-673-2000
  • Fax: 757-695-2722
Mailing address:
  • Phone: 757-673-2000
  • Fax: 757-695-2722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberCPO02937
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: