Provider Demographics
NPI:1689614919
Name:SKELTON, MATTHEW R (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:R
Last Name:SKELTON
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 601507
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1507
Mailing Address - Country:US
Mailing Address - Phone:540-982-0237
Mailing Address - Fax:540-982-1865
Practice Address - Street 1:2013 JEFFERSON ST SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-2419
Practice Address - Country:US
Practice Address - Phone:540-982-0237
Practice Address - Fax:540-982-1865
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200500613207RH0003X
VA0101242462207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAOO6618026Medicaid
VA350917OtherANTHEM
VA2180204OtherUNITED HEALTHCARE
VA3977371OtherCIGNA
VA7988607OtherAETNA
H76411Medicare UPIN
VAOO6618026Medicaid