Provider Demographics
NPI:1417924465
Name:MATTHEWS, DANIEL ALAN (PA-C)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:ALAN
Last Name:MATTHEWS
Suffix:
Gender:M
Credentials:PA-C
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 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:236 MARKET ST STE 110
Practice Address - Street 2:
Practice Address - City:LOCUST
Practice Address - State:NC
Practice Address - Zip Code:28097-9439
Practice Address - Country:US
Practice Address - Phone:704-384-9590
Practice Address - Fax:704-384-9591
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103285363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC970021975 RAILROADMedicare PIN
P41418Medicare UPIN
NC2753492AMedicare PIN