Provider Demographics
NPI:1003234162
Name:MCDIARMID, MATTHEW M (DO)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:M
Last Name:MCDIARMID
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:805 E 144TH AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80023-9210
Mailing Address - Country:US
Mailing Address - Phone:720-772-8040
Mailing Address - Fax:720-805-1551
Practice Address - Street 1:805 E 144TH AVE STE 100
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80023-9210
Practice Address - Country:US
Practice Address - Phone:720-772-8040
Practice Address - Fax:720-805-1551
Is Sole Proprietor?:No
Enumeration Date:2014-04-04
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI67343207R00000X
CODR.0065978207R00000X, 207RC0000X, 207UN0901X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100080074Medicaid