Provider Demographics
NPI:1538341854
Name:MATTHEW MORGAN TIGNOR MD
Entity type:Organization
Organization Name:MATTHEW MORGAN TIGNOR MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:M
Authorized Official - Last Name:TIGNOR
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:757-491-3130
Mailing Address - Street 1:1064 LASKIN RD
Mailing Address - Street 2:14
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-6337
Mailing Address - Country:US
Mailing Address - Phone:757-491-3130
Mailing Address - Fax:757-491-3512
Practice Address - Street 1:1064 LASKIN RD
Practice Address - Street 2:14
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-6337
Practice Address - Country:US
Practice Address - Phone:757-491-3130
Practice Address - Fax:757-491-3512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101029409207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
227640557OtherCHAMPUS
220771OtherMDIPA
029575OtherBC/BS
110015831OtherRAILROAD MEDICARE
17970OtherOPTIMA
NC890579EOtherMEDICAID NC
VA006099181Medicaid
17970OtherOPTIMA