Provider Demographics
NPI:1689632234
Name:MATTHEWS, DAVID EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:EDWARD
Last Name:MATTHEWS
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 1:545 BARNHILL DRIVE
Mailing Address - Street 2:EH 523
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-5125
Mailing Address - Country:US
Mailing Address - Phone:317-274-3086
Mailing Address - Fax:317-278-1886
Practice Address - Street 1:545 BARNHILL DRIVE
Practice Address - Street 2:EH 523
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5125
Practice Address - Country:US
Practice Address - Phone:317-274-3086
Practice Address - Fax:317-278-1886
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1036620A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN233690VMedicare ID - Type Unspecified
H54340Medicare UPIN