Provider Demographics
NPI:1376591248
Name:MATHEWS, HALLETT HOLMES (MD)
Entity Type:Individual
Prefix:
First Name:HALLETT
Middle Name:HOLMES
Last Name:MATHEWS
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 1:7650 E PARHAM RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23294-4306
Mailing Address - Country:US
Mailing Address - Phone:804-270-5163
Mailing Address - Fax:804-270-0079
Practice Address - Street 1:7650 E PARHAM RD
Practice Address - Street 2:SUITE 301
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23294-4373
Practice Address - Country:US
Practice Address - Phone:804-270-5163
Practice Address - Fax:804-270-0079
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101033359174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4232052OtherAETNA
VA225703OtherMDIPA,MAMSI,OPTIMUM CHOIC
VA77389OtherSENTARA-OPTIMA HEALTH
VA785172OtherUS HEALTHCARE-AETNA HMO
VA10870OtherCARENET-MEDICAID
VA7512553OtherCIGNA
VA63476OtherSOUTHERN HEALTH
VA040085OtherANTHEM BC/S
VA77389OtherSENTARA-OPTIMA HEALTH