Provider Demographics
NPI:1003827403
Name:MATHEW, THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:MATHEW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2730 ARNOLD RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:HAMPTONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27020-4038
Mailing Address - Country:US
Mailing Address - Phone:336-468-1642
Mailing Address - Fax:
Practice Address - Street 1:2730 ARNOLD RD
Practice Address - Street 2:
Practice Address - City:HAMPTONVILLE
Practice Address - State:NC
Practice Address - Zip Code:27020-7106
Practice Address - Country:US
Practice Address - Phone:336-469-1642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV09592207L00000X
VA0101036233207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0057893000Medicaid
VA005738962Medicaid
WVD49522Medicare UPIN
VA005738962Medicaid
VA190001252Medicare PIN
WV050016883Medicare PIN