Provider Demographics
NPI:1457318503
Name:MARCHAL, MATTHEW WALTER (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:WALTER
Last Name:MARCHAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 PUDDLEDOCK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:PRINCE GEORGE
Mailing Address - State:VA
Mailing Address - Zip Code:23875-1268
Mailing Address - Country:US
Mailing Address - Phone:804-526-1111
Mailing Address - Fax:804-526-2978
Practice Address - Street 1:4700 PUDDLEDOCK RD STE 300
Practice Address - Street 2:
Practice Address - City:PRINCE GEORGE
Practice Address - State:VA
Practice Address - Zip Code:23875-1268
Practice Address - Country:US
Practice Address - Phone:804-526-1111
Practice Address - Fax:804-526-2978
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA070678207Q00000X
VA0101058012207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003139521AMedicaid
00V911A02Medicare ID - Type UnspecifiedMEDICARE
P00166136Medicare ID - Type UnspecifiedMEDICARE RAILROAD
C09044Medicare ID - Type UnspecifiedMEDICARE OFFICE
G74009Medicare UPIN