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1508861998

NPI Code Detail

MEDICARE: MATTHEW CHET RADACK MD

MEDICARE: MATTHEW CHET RADACK MD

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	207P00000X	Emergency Medicine Physician	9701118	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	930084659	OTHER	NC	RAILROAD MEDICARE
5	930077046	OTHER	NC	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1072P	OTHER	NC	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	B4555	OTHER		MEDCOST
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	01-28748	OTHER	NC	UNITED HEALTHCARE

General Provider Information

NPI Number	:	1508861998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW CHET RADACK MD

Provider Business Mailing Address
First Line	:	1202 MEDICAL CENTER DR
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28401-7307
Country	:	US
Telephone Number	:	910-341-3300
Fax Number	:	910-251-2067

Provider Business Practice Location Address
First Line	:	4402 SHIPYARD BLVD
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28403-6161
Country	:	US
Telephone Number	:	910-452-1400
Fax Number	:	910-332-1072

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

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	03/17/2020

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Directions to “ MATTHEW CHET RADACK MD” Practice Location

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