Provider Demographics
NPI:1649213158
Name:MATTHEWS, CAROLYN M (MD)
Entity type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:M
Last Name:MATTHEWS
Suffix:
Gender:F
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:PO BOX 748613
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-8613
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8640 SUDLEY RD STE 303
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4404
Practice Address - Country:US
Practice Address - Phone:571-261-3529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7786207VX0201X
VA0101043061207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX139789502Medicaid
TX139789503Medicaid
TX139789519Medicaid
TX139789520Medicaid
TX8R1498OtherBLUE CROSS OF TX
TX139789501Medicaid
TX139789505Medicaid
TX139789506Medicaid
TX139789507Medicaid
TX139789508Medicaid
TX139789509Medicaid
NM000V7922Medicaid
TX139789511Medicaid
OK100221480AMedicaid
TX84X661Medicare PIN
TXE37358Medicare UPIN
TX139789506Medicaid
TX83W171Medicare PIN
TX139789511Medicaid
TX139789520Medicaid
TX139789501Medicaid
TX88G363Medicare PIN