Provider Demographics
NPI:1043298334
Name:CARPENTER, MATTHEW TRENT (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:TRENT
Last Name:CARPENTER
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 1:450 MAYO DR
Mailing Address - Street 2:
Mailing Address - City:GALESBURG
Mailing Address - State:IL
Mailing Address - Zip Code:61401-1211
Mailing Address - Country:US
Mailing Address - Phone:309-672-5700
Mailing Address - Fax:309-671-2774
Practice Address - Street 1:221 NE GLEN OAK AVE
Practice Address - Street 2:DEPARTMENT OF RADIATION ONCOLOGY
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61636-0001
Practice Address - Country:US
Practice Address - Phone:309-672-5700
Practice Address - Fax:309-671-2774
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM29182085R0001X
IL036.1262162085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX202746801Medicaid
TX8L14434Medicare Oscar/Certification
TXI50036Medicare UPIN