Provider Demographics
NPI:1417955410
Name:STRUPP, MATTHEW LLOYD (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:LLOYD
Last Name:STRUPP
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 1:4340 RIVER BLUFF TER
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27409-9201
Mailing Address - Country:US
Mailing Address - Phone:336-834-8473
Mailing Address - Fax:
Practice Address - Street 1:1000 SPRING GARDEN STREET
Practice Address - Street 2:ANNA GOVE STUDENT HEALTH CENTER
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27402-6170
Practice Address - Country:US
Practice Address - Phone:336-334-3142
Practice Address - Fax:336-334-5343
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101222363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical