Provider Demographics
NPI:1639268444
Name:STICH, MATTHEW (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:STICH
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 248
Mailing Address - Street 2:
Mailing Address - City:BASYE
Mailing Address - State:VA
Mailing Address - Zip Code:22810-0248
Mailing Address - Country:US
Mailing Address - Phone:703-494-5200
Mailing Address - Fax:888-534-2234
Practice Address - Street 1:6900 ATMORE DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-5644
Practice Address - Country:US
Practice Address - Phone:804-674-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101041202207RC0200X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC236037OtherPTAN
VA451960OtherBCBS
VA006303242Medicaid
DC236037Medicare PIN
DC236037OtherPTAN
VA451960OtherBCBS
VA180000857Medicare PIN