Provider Demographics
NPI:1639122591
Name:LONERGAN, MATTHEW (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:LONERGAN
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 1:520 COUNTRY CLUB PKWY
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-6043
Mailing Address - Country:US
Mailing Address - Phone:415-683-5001
Mailing Address - Fax:
Practice Address - Street 1:520 COUNTRY CLUB
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-6036
Practice Address - Country:US
Practice Address - Phone:541-683-5001
Practice Address - Fax:541-683-1422
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00034123207R00000X, 207RH0003X
ORMD171696207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1639122591Medicaid
WA900004086OtherRAILROAD MEDICARE
WA0291409OtherL&I
WA1315080001Medicare NSC
WAAB27481Medicare PIN
WA0291409OtherL&I
WA8907309Medicare PIN