Provider Demographics
NPI:1780896340
Name:BILLUPS, MATTHEW BRENT (DO)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:BRENT
Last Name:BILLUPS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 BERRYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CALLAWAY
Mailing Address - State:VA
Mailing Address - Zip Code:24067-5836
Mailing Address - Country:US
Mailing Address - Phone:540-483-0613
Mailing Address - Fax:
Practice Address - Street 1:3707 BRAMBLETON AVE STE 2
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-3658
Practice Address - Country:US
Practice Address - Phone:540-725-7800
Practice Address - Fax:540-989-6752
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102201962207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1780896340Medicaid
VA1780896340Medicaid
P00414968Medicare PIN
VA017969C18Medicare PIN