Provider Demographics
NPI:1922327774
Name:MATTHEWS, ANGELA (DO)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2694 JUDGE FRAN JAMIESON WAY
Mailing Address - Street 2:OVERFLOW PARKING LOT
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940
Mailing Address - Country:US
Mailing Address - Phone:321-252-1169
Mailing Address - Fax:
Practice Address - Street 1:2694 JUDGE FRAN JAMIESON WAY
Practice Address - Street 2:OVERFLOW PARKING LOT
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940
Practice Address - Country:US
Practice Address - Phone:321-252-1169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-19
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS14718207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH156900OtherMEDICARE PTAN
OH0078310Medicaid