Provider Demographics
NPI:1376579136
Name:MATTHEWS, HARRY MARQUETTE (PA)
Entity Type:Individual
Prefix:MR
First Name:HARRY
Middle Name:MARQUETTE
Last Name:MATTHEWS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 ENGLISH RD
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-6023
Mailing Address - Country:US
Mailing Address - Phone:252-937-4100
Mailing Address - Fax:252-937-4103
Practice Address - Street 1:804 ENGLISH RD
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-6023
Practice Address - Country:US
Practice Address - Phone:252-937-4100
Practice Address - Fax:252-937-4103
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC100071363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2746782Medicare ID - Type Unspecified