Provider Demographics
NPI:1841002094
Name:MCELROY, MATHEW LEE (BSN)
Entity type:Individual
Prefix:
First Name:MATHEW
Middle Name:LEE
Last Name:MCELROY
Suffix:
Gender:M
Credentials:BSN
Other - Prefix:
Other - First Name:MATHEW
Other - Middle Name:LEE
Other - Last Name:WALLACE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2048 SCARLET PINE RD
Mailing Address - Street 2:
Mailing Address - City:DUMFRIES
Mailing Address - State:VA
Mailing Address - Zip Code:22026-2945
Mailing Address - Country:US
Mailing Address - Phone:843-505-0808
Mailing Address - Fax:
Practice Address - Street 1:620 JOHN PAUL JONES CIR
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23708-2111
Practice Address - Country:US
Practice Address - Phone:757-953-7997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-24
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program