Provider Demographics
NPI:1801887732
Name:MATTISON, PARNELL CHARLES (DO)
Entity type:Individual
Prefix:DR
First Name:PARNELL
Middle Name:CHARLES
Last Name:MATTISON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7807 BLUE JASMINE CT
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22153-2128
Mailing Address - Country:US
Mailing Address - Phone:703-455-3355
Mailing Address - Fax:
Practice Address - Street 1:9501 FARRELL ROAD
Practice Address - Street 2:PEDIATRIC SERVICE
Practice Address - City:FORT BELVOIR
Practice Address - State:VA
Practice Address - Zip Code:22060
Practice Address - Country:US
Practice Address - Phone:703-805-0531
Practice Address - Fax:703-805-9024
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA050860208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics