Provider Demographics
NPI:1114904539
Name:NIEMI, MATTHEW GREGORY (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:GREGORY
Last Name:NIEMI
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 1:9802 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-4211
Mailing Address - Country:US
Mailing Address - Phone:757-926-4356
Mailing Address - Fax:
Practice Address - Street 1:45 PINE ST
Practice Address - Street 2:
Practice Address - City:LANGLEY AFB
Practice Address - State:VA
Practice Address - Zip Code:23665-2025
Practice Address - Country:US
Practice Address - Phone:757-764-9767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01054815A2085R0202X
VA01012394512085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology