Provider Demographics
NPI:1376616367
Name:MATTHEWS, CALVIN C (MD)
Entity Type:Individual
Prefix:DR
First Name:CALVIN
Middle Name:C
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 1:323 BELLEVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-3648
Mailing Address - Country:US
Mailing Address - Phone:973-429-1010
Mailing Address - Fax:973-429-1199
Practice Address - Street 1:323 BELLEVILLE AVE
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-3648
Practice Address - Country:US
Practice Address - Phone:973-429-1010
Practice Address - Fax:973-429-1199
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA49180261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3584607Medicaid
NJ223054468OtherTAX ID
NJ3584607Medicaid