Provider Demographics
NPI:1750518718
Name:SHAVER, MATTHEW ALLEN (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ALLEN
Last Name:SHAVER
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:PO BOX 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:105 YADKIN ST
Practice Address - Street 2:STE 203
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-3449
Practice Address - Country:US
Practice Address - Phone:980-323-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-17
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2014-01085208600000X
NC201401085208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNCI683AOtherMEDICARE
NC1750518718Medicaid
NC187E7OtherBCBS
NC201401085OtherNC LICENSE
NCNCI683AOtherMEDICARE