Provider Demographics
NPI:1104036086
Name:R. MICHAEL MATCHETT, M.D., P.C.
Entity Type:Organization
Organization Name:R. MICHAEL MATCHETT, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MATCHETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-481-1278
Mailing Address - Street 1:1018 CATON DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-3140
Mailing Address - Country:US
Mailing Address - Phone:757-481-1278
Mailing Address - Fax:
Practice Address - Street 1:1018 CATON DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-3140
Practice Address - Country:US
Practice Address - Phone:757-481-1278
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101032294207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5731046Medicaid
VAB62074Medicare UPIN
VA050000145Medicare ID - Type Unspecified