Basic Information
| Provider Information | |||||||||
| NPI: | 1609839091 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MATTSON | ||||||||
| FirstName: | MELANIE | ||||||||
| MiddleName: | DANIELLE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 220 CAMPUS BLVD STE 100 | ||||||||
| Address2: | |||||||||
| City: | WINCHESTER | ||||||||
| State: | VA | ||||||||
| PostalCode: | 226012896 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5405365100 | ||||||||
| FaxNumber: | 5405360235 | ||||||||
| Practice Location | |||||||||
| Address1: | 1880 AMHERST STREET | ||||||||
| Address2: | SUITE 100 AND SUITE 200 | ||||||||
| City: | WINCHESTER | ||||||||
| State: | VA | ||||||||
| PostalCode: | 22601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5406620306 | ||||||||
| FaxNumber: | 8552642066 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2006 | ||||||||
| LastUpdateDate: | 09/14/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 0101642786 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 412529100 | 05 | MD | MEDICAID | 006012124 | 05 | VA | MEDICAID | 0075072000 | 05 | WV | MEDICAID | 2119642 | 01 | MAMSI PROFESSIONAL | OTHER | 100465 | 01 | ANTHEM PROFESSIONAL | OTHER | 44155 | 01 | SENTARA PROFESSIONAL | OTHER | C00085 | 01 | VA | VA MEDICARE GROUP | OTHER | P00656342 | 01 | RAILROAD MEDICARE | OTHER | 000553833 | 01 | WV | WV BLUE SHIELD | OTHER | 08247400000 | 01 | QUALCHOICE PROFESSIONAL | OTHER | 3810003817 | 01 | WV | WV MEDICAID GROUP | OTHER | 550941600 | 01 | MD | MD MEDICARE GROUP | OTHER |