Provider Demographics
NPI:1255329959
Name:HUTCHINSON, MATHEW D (MD)
Entity Type:Individual
Prefix:
First Name:MATHEW
Middle Name:D
Last Name:HUTCHINSON
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 1:1625 N CAMPBELL AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-4330
Mailing Address - Country:US
Mailing Address - Phone:520-694-5745
Mailing Address - Fax:520-874-3457
Practice Address - Street 1:1625 N CAMPBELL AVENUE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85724-4306
Practice Address - Country:US
Practice Address - Phone:520-874-3457
Practice Address - Fax:520-874-3457
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD422188207R00000X, 207RC0000X, 207RC0001X
AZ52342207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1012758880001Medicaid
PA084442Medicare PIN
PA1012758880001Medicaid
PA084442NYVMedicare PIN