Healthcare Provider Details

I. General information

NPI: 1235983057
Provider Name (Legal Business Name): ASHLEY ANN MATIAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2024
Last Update Date: 04/17/2024
Certification Date: 04/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 JOHN PAUL JONES CIR
PORTSMOUTH VA
23708-2111
US

IV. Provider business mailing address

2010 WATERSIDE DR APT 103
SUFFOLK VA
23434-5583
US

V. Phone/Fax

Practice location:
  • Phone: 757-953-2277
  • Fax:
Mailing address:
  • Phone: 707-718-4202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: