Provider Demographics
NPI:1114964988
Name:MATTHEWS, JAMES HARVEY (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:HARVEY
Last Name:MATTHEWS
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 1:227 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LACKAWANNA
Mailing Address - State:NY
Mailing Address - Zip Code:14218-1156
Mailing Address - Country:US
Mailing Address - Phone:716-822-5944
Mailing Address - Fax:716-822-3937
Practice Address - Street 1:227 RIDGE RD
Practice Address - Street 2:
Practice Address - City:LACKAWANNA
Practice Address - State:NY
Practice Address - Zip Code:14218-1156
Practice Address - Country:US
Practice Address - Phone:716-822-5944
Practice Address - Fax:716-822-3937
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY131142207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RB2517OtherMEDICARE ID TYPE UNS;PECIFIED
B36091Medicare UPIN