Provider Demographics
NPI:1649234634
Name:MATTHEWS, BRANDY R (MD)
Entity Type:Individual
Prefix:DR
First Name:BRANDY
Middle Name:R
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:STE 130 PROVIDER ENROLLMENT
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1001 W 10TH ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-2859
Practice Address - Country:US
Practice Address - Phone:317-630-7979
Practice Address - Fax:317-630-2668
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA923892084N0400X
IN01064983A2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A923890Medicaid
IN200899010Medicaid
INP01002410OtherRAILROAD MEDICARE PTAN
CA00A923890Medicare PIN
IN262210LLMedicare PIN
INP01002410OtherRAILROAD MEDICARE PTAN