Provider Demographics
NPI:1508861998
Name:RADACK, MATTHEW CHET (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:CHET
Last Name:RADACK
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 1:1202 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7307
Mailing Address - Country:US
Mailing Address - Phone:910-341-3300
Mailing Address - Fax:910-251-2067
Practice Address - Street 1:4402 SHIPYARD BLVD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6161
Practice Address - Country:US
Practice Address - Phone:910-452-1400
Practice Address - Fax:910-332-1072
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9701118207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1072POtherBCBS
NC891072PMedicaid
B4555OtherMEDCOST
NC930084659OtherRAILROAD MEDICARE
NC930077046OtherRAILROAD MEDICARE
SCQ01118Medicaid
NC01-28748OtherUNITED HEALTHCARE
NC930084659OtherRAILROAD MEDICARE
G58638Medicare UPIN
NC2246356CMedicare PIN