Provider Demographics
NPI:1376003376
Name:NIER, MATTHEW GRANT (DO)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:GRANT
Last Name:NIER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3129 ANTELOPE RIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-4239
Mailing Address - Country:US
Mailing Address - Phone:303-956-4581
Mailing Address - Fax:
Practice Address - Street 1:11850 FREEDOM DR APT 1213
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-6065
Practice Address - Country:US
Practice Address - Phone:303-956-4581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-25
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0102208472208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program