Healthcare Provider Details

I. General information

NPI: 1639382898
Provider Name (Legal Business Name): MATTHEW W HUFFMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 05/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2410 ATHERHOLT RD
LYNCHBURG VA
24501-2148
US

IV. Provider business mailing address

2410 ATHERHOLT RD
LYNCHBURG VA
24501-2148
US

V. Phone/Fax

Practice location:
  • Phone: 434-200-5252
  • Fax: 434-200-2851
Mailing address:
  • Phone: 434-200-5252
  • Fax: 434-200-2851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number0116018304
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101245484
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number0101245484
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: