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General NPI Number Information
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NPI Number | 1528326170
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Entity Type | Individual
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Provider Name | MARTINS CHIMA MATTHEW M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/01/2012
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Last Update Date | 01/11/2017
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Provider Practice Location Address
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Address Line | 807 CHILDRENS WAY NEMOURS CHILDRENS SPECIALTY CARE, JACKSONVILLE
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City | JACKSONVILLE
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State | FL
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Zip | 32207-8426
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Country | US
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Telephone | 904-697-3600
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Fax | 904-697-3927
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Provider Business Mailing Address
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Address Line | PO BOX 191 PROVIDER ENROLLMENT DEPARTMENT
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City | ROCKLAND
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State | DE
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Zip | 19732-0191
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Country | US
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Telephone | 302-651-6212
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Fax | 302-651-4945
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | ME127275
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License Number State | FL
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