Provider Demographics
NPI:1295544955
Name:MATHIAS, ANDREW M (CPO)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:M
Last Name:MATHIAS
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3705 HENDERSON DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-5237
Mailing Address - Country:US
Mailing Address - Phone:252-638-1312
Mailing Address - Fax:252-631-1859
Practice Address - Street 1:3705 HENDERSON DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-5237
Practice Address - Country:US
Practice Address - Phone:910-988-9057
Practice Address - Fax:910-378-7044
Is Sole Proprietor?:No
Enumeration Date:2025-01-06
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist