Provider Demographics
NPI:1124087945
Name:INDECK, MATTHEW C (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:C
Last Name:INDECK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:330 NC 108 HWY
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORDTON
Mailing Address - State:NC
Mailing Address - Zip Code:28139-3188
Mailing Address - Country:US
Mailing Address - Phone:828-286-1743
Mailing Address - Fax:828-287-3731
Practice Address - Street 1:330 NC 108 HWY
Practice Address - Street 2:
Practice Address - City:RUTHERFORDTON
Practice Address - State:NC
Practice Address - Zip Code:28139-3188
Practice Address - Country:US
Practice Address - Phone:828-286-1743
Practice Address - Fax:828-287-3731
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2015-01969208600000X, 2086S0102X
PAMD033647E208600000X, 2086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1124087945Medicaid
PA137997Medicare ID - Type Unspecified