Provider Demographics
NPI:1811136260
Name:MATOS, NARA J (MD)
Entity type:Individual
Prefix:DR
First Name:NARA
Middle Name:J
Last Name:MATOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:NARA
Other - Middle Name:J
Other - Last Name:MATOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:101 FRANK ST
Mailing Address - Street 2:
Mailing Address - City:STAFFORDSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41256-9098
Mailing Address - Country:US
Mailing Address - Phone:787-981-7700
Mailing Address - Fax:
Practice Address - Street 1:1540 SPRING VALLEY DR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25704
Practice Address - Country:US
Practice Address - Phone:787-981-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-09
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17421208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice