Healthcare Provider Details

I. General information

NPI: 1538990684
Provider Name (Legal Business Name): CONNOR ALEXANDER MATAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2024
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 MYERS CORNER DR
STAUNTON VA
24401-6342
US

IV. Provider business mailing address

25 MYERS CORNER DR
STAUNTON VA
24401-6342
US

V. Phone/Fax

Practice location:
  • Phone: 540-688-2646
  • Fax: 540-688-2656
Mailing address:
  • Phone: 540-688-2646
  • Fax: 540-688-2656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: