Provider Demographics
NPI:1932166683
Name:MATTHEWS PLASTIC SURGERY ASSOC PA
Entity Type:Organization
Organization Name:MATTHEWS PLASTIC SURGERY ASSOC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:BICKET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-845-9800
Mailing Address - Street 1:1450 MATTHEWS TOWNSHIP PKWY
Mailing Address - Street 2:SUITE 270
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-2387
Mailing Address - Country:US
Mailing Address - Phone:704-845-9800
Mailing Address - Fax:704-845-9890
Practice Address - Street 1:1450 MATTHEWS TOWNSHIP PKWY
Practice Address - Street 2:SUTIE 270
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-2387
Practice Address - Country:US
Practice Address - Phone:704-845-9800
Practice Address - Fax:704-845-9890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-27
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891541BMedicaid
NC891541BMedicaid