Provider Demographics
NPI:1770576266
Name:MATIAS, ESTHER (MD)
Entity type:Individual
Prefix:DR
First Name:ESTHER
Middle Name:
Last Name:MATIAS
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 1:1707 BELLE VIEW BLVD
Mailing Address - Street 2:A-2
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22307-6727
Mailing Address - Country:US
Mailing Address - Phone:703-765-3520
Mailing Address - Fax:703-765-9718
Practice Address - Street 1:1707 BELLE VIEW BLVD
Practice Address - Street 2:A-2
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22307-6727
Practice Address - Country:US
Practice Address - Phone:703-765-3520
Practice Address - Fax:703-765-9718
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101026167207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC26070001OtherCARE FIRST
MD5411127240004OtherCIGNA
VA067105OtherBCBS - TRIGON HLTH KEEPER
VA5850134Medicaid
VA067105OtherBCBS - TRIGON HLTH KEEPER
C62598Medicare UPIN