Provider Demographics
NPI:1629023601
Name:MATTHEWS HEMATOLOGY ONCOLOGY ASSOCIATES
Entity Type:Organization
Organization Name:MATTHEWS HEMATOLOGY ONCOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:FOULKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-847-0861
Mailing Address - Street 1:1700 MATTHEWS TOWNSHIP PKWY
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-4658
Mailing Address - Country:US
Mailing Address - Phone:704-841-8151
Mailing Address - Fax:704-841-9228
Practice Address - Street 1:1700 MATTHEWS TOWNSHIP PKWY
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-4658
Practice Address - Country:US
Practice Address - Phone:704-841-8151
Practice Address - Fax:704-841-9228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC015W8OtherBLUE CROSS/BLUE SHIELD
NC89015W8Medicaid
SCNPB040Medicaid
SCNPB040Medicaid