1659325488 NPI number — ADORA L MATTHEWS MD

Table of content: ADORA L MATTHEWS MD (NPI 1659325488)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659325488 NPI number — ADORA L MATTHEWS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MATTHEWS
Provider First Name:
ADORA
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1659325488
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/21/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1329 HOWE AVE
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
SACRAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95825-3363
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-678-6760
Provider Business Mailing Address Fax Number:
916-678-6761

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6 MEDICAL PLAZA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROSEVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95661-3037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-781-1000
Provider Business Practice Location Address Fax Number:
843-673-7336
Provider Enumeration Date:
05/19/2006

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: 208100000X , with the licence number:  18023 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7906300 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 180235 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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