Provider Demographics
NPI:1538990684
Name:MATAS, CONNOR ALEXANDER
Entity type:Individual
Prefix:
First Name:CONNOR
Middle Name:ALEXANDER
Last Name:MATAS
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 1:150 SUNDOWN COVE DR
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-9188
Mailing Address - Country:US
Mailing Address - Phone:704-495-2396
Mailing Address - Fax:
Practice Address - Street 1:214 BUSH RIVER DR
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:VA
Practice Address - Zip Code:23901-3179
Practice Address - Country:US
Practice Address - Phone:704-495-2396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant