Provider Demographics
NPI:1881728079
Name:MATTHEW STICH, MD
Entity type:Organization
Organization Name:MATTHEW STICH, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:STICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-494-5200
Mailing Address - Street 1:PO BOX 248
Mailing Address - Street 2:
Mailing Address - City:BASYE
Mailing Address - State:VA
Mailing Address - Zip Code:22810-0248
Mailing Address - Country:US
Mailing Address - Phone:703-494-5200
Mailing Address - Fax:888-534-2234
Practice Address - Street 1:6900 ATMORE DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-5644
Practice Address - Country:US
Practice Address - Phone:703-494-5200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA207W00000X
261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty