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Individual

MATTHEW L JUSTUS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
202 TOWN SQUARE ST., GLADE SPRING, VA 24340
(276) 429-1410
(276) 783-2879
Mailing address
16000 JOHNSTON MEMORIAL DR, ABINGDON, VA 24211-7659
(276) 258-4050
(276) 258-4056

Taxonomy

Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
0110001912
VA
363A00000X
Physician Assistant
Primary
0110001912
VA
363A00000X
Physician Assistant
01170
WV

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1821033895
VA
01
P01198022
RR MEDICARE
VA
05
Q007384
TN
Enumeration date
06/16/2006
Last updated
05/20/2021
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