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Individual
DR. MICHAEL T MATTINGLY
Active
Individual
DR. MICHAEL T MATTINGLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
9500996
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1036N
BCBS PROVIDER #
NC
01
—
19495
PARTNERS
NC
01
—
3102727
UHC PROVIDER #
NC
01
—
390004560
RRM PROVIDER #
NC
01
—
561274347
CKA'S TAX ID #
NC
05
—
891036N
—
NC
Enumeration date
06/05/2006
Last updated
05/20/2013
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