Provider Demographics
NPI:1225086762
Name:MATTHEWS, ANDREW LEE (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:LEE
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 1:7109 HANGING ROCK CT
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:NC
Mailing Address - Zip Code:28037-6107
Mailing Address - Country:US
Mailing Address - Phone:704-421-4172
Mailing Address - Fax:
Practice Address - Street 1:1025 MARSH ST
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-4752
Practice Address - Country:US
Practice Address - Phone:507-625-4549
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200000267207P00000X
MN64659207P00000X
MA286873207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC127PMOtherBCBS
SCQ0026CMedicaid
NC89127PMMedicaid
930094506Medicare PIN
SCQ0026CMedicaid
NCG32322Medicare UPIN