Provider Demographics
NPI:1609805332
Name:MATTHIAS, DWIGHT FITZGERALD (MD)
Entity Type:Individual
Prefix:DR
First Name:DWIGHT
Middle Name:FITZGERALD
Last Name:MATTHIAS
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 1345
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23327-1345
Mailing Address - Country:US
Mailing Address - Phone:757-436-0909
Mailing Address - Fax:757-436-0169
Practice Address - Street 1:11803 JEFFERSON AVE
Practice Address - Street 2:PORT WARWICK MEDICAL ARTS SUITE 236
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-2565
Practice Address - Country:US
Practice Address - Phone:757-594-1072
Practice Address - Fax:757-594-1195
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101229098207RE0101X
CAA63168207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101229098OtherVA LICENSE
VAH34088Medicare UPIN
VA0101229098OtherVA LICENSE