Provider Demographics
NPI:1912040452
Name:FAVINGER, MATTHEW (MS)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:
Last Name:FAVINGER
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28302 GRAVEL HILL RD
Mailing Address - Street 2:
Mailing Address - City:MILLSBORO
Mailing Address - State:DE
Mailing Address - Zip Code:19966-3956
Mailing Address - Country:US
Mailing Address - Phone:302-934-1471
Mailing Address - Fax:302-934-9687
Practice Address - Street 1:28302 GRAVEL HILL RD
Practice Address - Street 2:
Practice Address - City:MILLSBORO
Practice Address - State:DE
Practice Address - Zip Code:19966-3956
Practice Address - Country:US
Practice Address - Phone:302-934-1471
Practice Address - Fax:302-934-9687
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE02-0000122231H00000X
DE03-0000143237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEG00813Medicare ID - Type UnspecifiedGROUP NUMBER