Healthcare Provider Details

I. General information

NPI: 1164692877
Provider Name (Legal Business Name): MATTHEW ALAN HOPSON D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2008
Last Update Date: 12/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5424 DISCOVERY PARK BLVD. SUITE 204
WILLIAMSBURG VA
23188
US

IV. Provider business mailing address

860 OMNI BLVD. SUITE 303
NEWPORT NEWS VA
23606
US

V. Phone/Fax

Practice location:
  • Phone: 757-345-5870
  • Fax: 757-345-6927
Mailing address:
  • Phone: 757-232-8769
  • Fax: 757-232-8875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number0103301012
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0103301012
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License Number0103301012
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: