Provider Demographics
NPI:1760437446
Name:FINE, MATTHEW NORMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:NORMAN
Last Name:FINE
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 1:2809 OLIVE HWY
Mailing Address - Street 2:SUITE 350
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95966
Mailing Address - Country:US
Mailing Address - Phone:530-532-8654
Mailing Address - Fax:530-538-3393
Practice Address - Street 1:2809 OLIVE HWY
Practice Address - Street 2:SUITE 350
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95966
Practice Address - Country:US
Practice Address - Phone:530-532-8654
Practice Address - Fax:530-538-3393
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG36657207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00273421OtherRAILROAD MEDICARE RRM
P00273421OtherRAILROAD MEDICARE RRM
CA00G366571Medicare ID - Type Unspecified
CA00G366570Medicare ID - Type Unspecified