Provider Demographics
NPI:1477519833
Name:KAREN, MATTHEW E (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:E
Last Name:KAREN
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 1:2365 OLD MILTON PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-2140
Mailing Address - Country:US
Mailing Address - Phone:770-740-1860
Mailing Address - Fax:
Practice Address - Street 1:1365 ROCK QUARRY RD STE 300
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-5024
Practice Address - Country:US
Practice Address - Phone:770-740-1860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA93362207Y00000X, 2082S0099X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA40017979OtherMEDICARE RR
VA6503560Medicaid
G91303Medicare UPIN
040000493Medicare ID - Type Unspecified