MEDICARE: MATTHEW MCCRAY ASHBY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0804X	Child & Adolescent Psychiatry Physician	036164412	IL
2	2084P0804X	Child & Adolescent Psychiatry Physician	01086800A	IN

General Provider Information

NPI Number	:	1346387826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW MCCRAY ASHBY M.D.

Provider Business Mailing Address
First Line	:	9250 COLUMBIA AVE STE 2E
Second Line	:
City	:	MUNSTER
State	:	IN
Zip	:	46321-3530
Country	:	US
Telephone Number	:	219-595-0043
Fax Number	:

Provider Business Practice Location Address
First Line	:	9250 COLUMBIA AVE STE 2E
Second Line	:
City	:	MUNSTER
State	:	IN
Zip	:	46321-3530
Country	:	US
Telephone Number	:	219-595-0043
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	06/12/2023

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