Provider Demographics
NPI:1144069519
Name:PEREIRA, MATTHEW A
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:A
Last Name:PEREIRA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 E LAWN AVE
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:OH
Mailing Address - Zip Code:43078-1446
Mailing Address - Country:US
Mailing Address - Phone:937-539-4777
Mailing Address - Fax:
Practice Address - Street 1:514 E LAWN AVE
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:OH
Practice Address - Zip Code:43078-1446
Practice Address - Country:US
Practice Address - Phone:937-539-4777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-23
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide