Provider Demographics
NPI:1528021706
Name:DICKSON, MATTHEW JORDAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:JORDAN
Last Name:DICKSON
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:100 PARK STREET
Mailing Address - Street 2:GLENS FALLS HOSPITAL - CREDENTIALING
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-4413
Mailing Address - Country:US
Mailing Address - Phone:518-926-5924
Mailing Address - Fax:518-926-6983
Practice Address - Street 1:14 HUDSON AVENUE
Practice Address - Street 2:ADIRONDACK ENT
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-4363
Practice Address - Country:US
Practice Address - Phone:518-926-1380
Practice Address - Fax:518-926-1385
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA57061207YS0123X
NY244280207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
No207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02897047Medicaid
156954Medicare UPIN
NYIA1213Medicare PIN