Provider Demographics
NPI:1336180959
Name:VOGEL, MATTHEW FREDERICK (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:FREDERICK
Last Name:VOGEL
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 1:7130 GLEN FOREST DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-3754
Mailing Address - Country:US
Mailing Address - Phone:804-288-4084
Mailing Address - Fax:804-282-8678
Practice Address - Street 1:102 DMV DR
Practice Address - Street 2:
Practice Address - City:KILMARNOCK
Practice Address - State:VA
Practice Address - Zip Code:22482-3843
Practice Address - Country:US
Practice Address - Phone:804-288-4084
Practice Address - Fax:804-559-2046
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101048305207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1336180959Medicaid
VA103644OtherANTHEM BCBS
VAP00152477OtherRR MEDICARE
VAVVD050AMedicare PIN
VAP00152477OtherRR MEDICARE
VAVVD050AMedicare PIN