Provider Demographics
NPI:1730137290
Name:GILLIHAN, MATTHEW DON (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:DON
Last Name:GILLIHAN
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 1:1107 REYNOLDS ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28112-4351
Mailing Address - Country:US
Mailing Address - Phone:704-752-7575
Mailing Address - Fax:704-752-7576
Practice Address - Street 1:1107 REYNOLDS ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-4351
Practice Address - Country:US
Practice Address - Phone:704-752-7575
Practice Address - Fax:704-752-7576
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2002-0453207Y00000X
NC2022-02773207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H60410Medicare UPIN