Provider Demographics
NPI:1740257831
Name:CUSANO, MATTHEW W (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:W
Last Name:CUSANO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1490 PARK AVE NW
Mailing Address - Street 2:SUITE 3
Mailing Address - City:NORTON
Mailing Address - State:VA
Mailing Address - Zip Code:24273-1631
Mailing Address - Country:US
Mailing Address - Phone:276-679-8890
Mailing Address - Fax:276-679-9740
Practice Address - Street 1:2858 SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-3420
Practice Address - Country:US
Practice Address - Phone:803-699-9073
Practice Address - Fax:866-527-0937
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2021-08-18
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Provider Licenses
StateLicense IDTaxonomies
VA0101236288207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1740257831Medicaid
P00670127OtherRR MEDICARE
KY7100066160Medicaid
VAC10456Medicare UPIN
H16094Medicare UPIN
VA1740257831Medicaid