Provider Demographics
NPI:1467722470
Name:VANALSTINE, MATTHEW PAUL
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:PAUL
Last Name:VANALSTINE
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 1:8057 CHARLEMONT RD
Mailing Address - Street 2:
Mailing Address - City:GOODE
Mailing Address - State:VA
Mailing Address - Zip Code:24556-3065
Mailing Address - Country:US
Mailing Address - Phone:540-266-3946
Mailing Address - Fax:540-266-3949
Practice Address - Street 1:8057 CHARLEMONT RD
Practice Address - Street 2:
Practice Address - City:GOODE
Practice Address - State:VA
Practice Address - Zip Code:24556-3065
Practice Address - Country:US
Practice Address - Phone:540-266-3946
Practice Address - Fax:540-266-3949
Is Sole Proprietor?:No
Enumeration Date:2012-01-06
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA27051131278A171W00000X, 171WH0202X
FLCBC1252455171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No171WH0202XOther Service ProvidersContractorHome Modifications