Provider Demographics
NPI:1235860826
Name:MATTHEWS, JOMIAH DAMIEN
Entity Type:Individual
Prefix:
First Name:JOMIAH
Middle Name:DAMIEN
Last Name:MATTHEWS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4190 LIVINGSTON RD SE APT 201
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-2913
Mailing Address - Country:US
Mailing Address - Phone:202-246-7764
Mailing Address - Fax:
Practice Address - Street 1:4190 LIVINGSTON RD SE APT 201
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-2913
Practice Address - Country:US
Practice Address - Phone:202-246-7764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-23
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No374U00000XNursing Service Related ProvidersHome Health Aide