Provider Demographics
NPI:1568444339
Name:COLLINS, MATTHEW TILL (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:TILL
Last Name:COLLINS
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 1:200 NASH MEDICAL ARTS MALL
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-1470
Mailing Address - Country:US
Mailing Address - Phone:252-443-5941
Mailing Address - Fax:252-443-7059
Practice Address - Street 1:200 NASH MEDICAL ARTS MALL
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-1470
Practice Address - Country:US
Practice Address - Phone:252-443-5941
Practice Address - Fax:252-443-7059
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200200509174400000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89131N9Medicaid
NC89131N9Medicaid
NCH70118Medicare UPIN