1184607848 NPI number — GEORGE E MATTHEWS MD

Table of content: GEORGE E MATTHEWS MD (NPI 1184607848)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184607848 NPI number — GEORGE E MATTHEWS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MATTHEWS
Provider First Name:
GEORGE
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184607848
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/12/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6460 MAIN STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILLIAMSVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14221
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-634-5100
Provider Business Mailing Address Fax Number:
716-634-5134

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6460 MAIN STREET
Provider Second Line Business Practice Location Address:
BUFFALO CARDIOLOGY & PULMONARY ASSOC PC
Provider Business Practice Location Address City Name:
WILLIAMSVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14221
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-634-5100
Provider Business Practice Location Address Fax Number:
716-634-5134
Provider Enumeration Date:
11/26/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  158119 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00010112903 . This is a "UNIVERA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000510832009 . This is a "BLUECROSS COMMUNITY BLUE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 833909 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2100908 . This is a "INDEPENDENT HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4903138 . This is a "INDEP HEALTHY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00010112901 . This is a "UNIVERA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".