Provider Demographics
NPI:1912194556
Name:MATTHEW MCQUAID, DPM, INC.
Entity Type:Organization
Organization Name:MATTHEW MCQUAID, DPM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:MCQUAID
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:707-263-3727
Mailing Address - Street 1:5150 HILL RD E STE A
Mailing Address - Street 2:
Mailing Address - City:LAKEPORT
Mailing Address - State:CA
Mailing Address - Zip Code:95453-5100
Mailing Address - Country:US
Mailing Address - Phone:707-263-3727
Mailing Address - Fax:707-263-5236
Practice Address - Street 1:5150 HILL RD E STE A
Practice Address - Street 2:
Practice Address - City:LAKEPORT
Practice Address - State:CA
Practice Address - Zip Code:95453-5100
Practice Address - Country:US
Practice Address - Phone:707-263-3727
Practice Address - Fax:707-263-5236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-27
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3998213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ17250ZMedicaid
CAU52547Medicare UPIN
CA1296960001Medicare NSC
CAZZZ17250ZMedicare PIN