Basic Information
| Provider Information | |||||||||
| NPI: | 1700130978 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | POWER | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | TIMOTHY | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 848932 | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022848932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8032969200 | ||||||||
| FaxNumber: | 8032969697 | ||||||||
| Practice Location | |||||||||
| Address1: | 104 SALUDA POINTE DR | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 290727295 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8032969200 | ||||||||
| FaxNumber: | 8032969697 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2012 | ||||||||
| LastUpdateDate: | 12/18/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | SC | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.