Provider Demographics
NPI:1396401741
Name:GOTTSCHALL, MATTHEW QUINTON
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:QUINTON
Last Name:GOTTSCHALL
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:PO BOX 727
Mailing Address - Street 2:
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-0727
Mailing Address - Country:US
Mailing Address - Phone:304-696-4747
Mailing Address - Fax:304-636-7724
Practice Address - Street 1:#1 FIFTH ST
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-2624
Practice Address - Country:US
Practice Address - Phone:304-636-4747
Practice Address - Fax:304-636-7724
Is Sole Proprietor?:No
Enumeration Date:2021-11-10
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant