Provider Demographics
NPI:1114026234
Name:PONDER, MATTHEW CARSON (MD,DVM)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:CARSON
Last Name:PONDER
Suffix:
Gender:M
Credentials:MD,DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5010 WARSAW PL APT 31
Mailing Address - Street 2:
Mailing Address - City:DULLES
Mailing Address - State:VA
Mailing Address - Zip Code:20189-5010
Mailing Address - Country:US
Mailing Address - Phone:844-355-7673
Mailing Address - Fax:
Practice Address - Street 1:DEPARTMENT OF STATE 2401 E STREET NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20522-1430
Practice Address - Country:US
Practice Address - Phone:844-355-7673
Practice Address - Fax:844-355-7673
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA052001207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO33439257Medicaid
FL49169XMedicare PIN