MEDICARE: DR. MATTHEW JON RICHTER D.O.

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	207Q00000X	Family Medicine Physician	DO00900	RI
2	207Q00000X	Family Medicine Physician	2016-00413	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639464837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW JON RICHTER D.O.

Provider Business Mailing Address
First Line	:	PO BOX 60447
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-0447
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6488 WEDDINGTON-MONROE RD
Second Line	:
City	:	WESLEY CHAPEL
State	:	NC
Zip	:	28104-7948
Country	:	US
Telephone Number	:	704-316-5650
Fax Number	:	704-316-5651

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

Provider Enumeration Date	:	06/15/2011
Last Update Date	:	02/09/2022

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