Provider Demographics
NPI:1841290525
Name:MATHEWS, EMMETT C JR (MD)
Entity type:Individual
Prefix:DR
First Name:EMMETT
Middle Name:C
Last Name:MATHEWS
Suffix:JR
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1928 RANDOLPH RD
Mailing Address - Street 2:STE 215
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28207-1105
Mailing Address - Country:US
Mailing Address - Phone:704-332-3632
Mailing Address - Fax:704-332-3891
Practice Address - Street 1:1928 RANDOLPH RD
Practice Address - Street 2:STE 215
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1105
Practice Address - Country:US
Practice Address - Phone:704-332-3632
Practice Address - Fax:704-332-3891
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2025-04-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC33089207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8954712Medicaid
SCN33089Medicaid
NC211872DMedicare PIN
SCN33089Medicaid