Provider Demographics
NPI:1518103001
Name:GODDARD, MATTHEW ARTHUR (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:ARTHUR
Last Name:GODDARD
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 601843
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1843
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:674 MERRIMON AVE STE 101
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28804-3586
Practice Address - Country:US
Practice Address - Phone:828-348-7418
Practice Address - Fax:828-348-7419
Is Sole Proprietor?:No
Enumeration Date:2009-01-05
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC0010-01633363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant