Provider Demographics
NPI:1205987500
Name:NIELSEN, MATTHEW EDWARD (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:EDWARD
Last Name:NIELSEN
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:UNC CHAPEL HILL DEPT OF SURGERY
Mailing Address - Street 2:UROLOGY: CAMPUS BOX 7235
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-0001
Mailing Address - Country:US
Mailing Address - Phone:919-843-8733
Mailing Address - Fax:919-966-0098
Practice Address - Street 1:UNC CHAPEL HILL DEPT OF SURGERY
Practice Address - Street 2:UROLOGY: CAMPUS BOX 7235
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-0001
Practice Address - Country:US
Practice Address - Phone:919-843-8733
Practice Address - Fax:919-966-0098
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0064034208800000X
NC2008-00910208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2008-00910OtherNORTH CAROLINA MEDICAL BOARD
MDD0064034OtherMEDICAL LICENSE
130672ZAM2Medicare PIN