Provider Demographics
NPI:1639464837
Name:RICHTER, MATTHEW JON (DO)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:JON
Last Name:RICHTER
Suffix:
Gender:M
Credentials:DO
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 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6488 WEDDINGTON-MONROE RD
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:NC
Practice Address - Zip Code:28104-7948
Practice Address - Country:US
Practice Address - Phone:704-316-5650
Practice Address - Fax:704-316-5651
Is Sole Proprietor?:No
Enumeration Date:2011-06-15
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDO00900207Q00000X
NC2016-00413207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1639464837Medicaid