Provider Demographics
NPI:1740266212
Name:MATTHEW, MAVIS LORRAINE (MD,MPH,FAAP)
Entity type:Individual
Prefix:DR
First Name:MAVIS
Middle Name:LORRAINE
Last Name:MATTHEW
Suffix:
Gender:F
Credentials:MD,MPH,FAAP
Other - Prefix:
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Mailing Address - Street 1:35 ESTATE LA GRANDE PRINCESS
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSTED
Mailing Address - State:VI
Mailing Address - Zip Code:00820
Mailing Address - Country:US
Mailing Address - Phone:340-773-4432
Mailing Address - Fax:340-773-7745
Practice Address - Street 1:35 ESTATE LA GRANDE PRINCESS
Practice Address - Street 2:
Practice Address - City:CHRISTIANSTED
Practice Address - State:VI
Practice Address - Zip Code:00820
Practice Address - Country:US
Practice Address - Phone:340-773-0427
Practice Address - Fax:340-773-7745
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VIVI794208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics