Provider Demographics
NPI:1063505873
Name:ARVON, MATTHEW P (DO)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:P
Last Name:ARVON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 147
Mailing Address - Street 2:
Mailing Address - City:DOROTHY
Mailing Address - State:WV
Mailing Address - Zip Code:25060-0147
Mailing Address - Country:US
Mailing Address - Phone:304-854-1324
Mailing Address - Fax:304-854-1996
Practice Address - Street 1:189 HOME SCHOOL VILLAGE
Practice Address - Street 2:
Practice Address - City:COLCORD
Practice Address - State:WV
Practice Address - Zip Code:25048
Practice Address - Country:US
Practice Address - Phone:304-854-1324
Practice Address - Fax:304-854-1996
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1659207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
001304980OtherBCBS
WV22603Medicaid
288995OtherUNITEDHEALTHCARE
206638OtherCARELINK
WV5600616000Medicaid
WVA01659Medicaid
WVH11006Medicare ID - Type UnspecifiedUGS MEDICARE
WV22603Medicaid
WV5600616000Medicaid
WVP00229602Medicare ID - Type UnspecifiedTRAVELERS MEDICARE