Provider Demographics
NPI:1588647028
Name:MESSIER, MATTHEW ROLAND (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ROLAND
Last Name:MESSIER
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:PO BOX 936857
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-6857
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7420 MARKET ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28411-9453
Practice Address - Country:US
Practice Address - Phone:910-686-2525
Practice Address - Fax:910-686-1606
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007-00620207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1588647028Medicaid
NC5907684Medicaid
VA005886686Medicaid
NC2071879CMedicare PIN
NC5907684Medicaid
VA001720C65Medicare PIN
NCH59786Medicare UPIN
NC2071879Medicare PIN