Provider Demographics
NPI:1679576086
Name:MATHEWS, HERBERT GRAHAM III
Entity Type:Individual
Prefix:MR
First Name:HERBERT
Middle Name:GRAHAM
Last Name:MATHEWS
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 BENTLEY RD
Mailing Address - Street 2:
Mailing Address - City:FREELAND
Mailing Address - State:MD
Mailing Address - Zip Code:21053-9517
Mailing Address - Country:US
Mailing Address - Phone:410-357-4402
Mailing Address - Fax:
Practice Address - Street 1:2401 W BELVEDERE AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-5216
Practice Address - Country:US
Practice Address - Phone:410-601-0674
Practice Address - Fax:410-601-7032
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD132501835P1200X
TN0086041835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy