Individual
DR. MICHAEL T MATTINGLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
309 NEW ST, GREENSBORO, NC 27405-3654
(336) 379-9708
(336) 379-8714
Mailing address
309 NEW ST, GREENSBORO, NC 27405-3654
(336) 379-9708
(336) 379-8714
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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