Healthcare Provider Details

I. General information

NPI: 1144226853
Provider Name (Legal Business Name): MATTHEW C DAIRMAN DPM, MS, FACFAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 01/19/2024
Certification Date: 01/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 N MAIN ST
SUFFOLK VA
23434-4507
US

IV. Provider business mailing address

171 N MAIN ST
SUFFOLK VA
23434-4507
US

V. Phone/Fax

Practice location:
  • Phone: 757-934-0768
  • Fax: 757-925-1901
Mailing address:
  • Phone: 757-934-0768
  • Fax: 757-925-1901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0103300887
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: