Provider Demographics
NPI:1669585634
Name:MATHEWS, MOLLY R (MD)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:R
Last Name:MATHEWS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:4536 BONNEY RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-3869
Mailing Address - Country:US
Mailing Address - Phone:757-490-9388
Mailing Address - Fax:757-490-9401
Practice Address - Street 1:736 BATTLEFIELD BLVD N
Practice Address - Street 2:CHESAPEAKE GENERAL HOSPITAL
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-4941
Practice Address - Country:US
Practice Address - Phone:757-490-9388
Practice Address - Fax:757-490-9401
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101236644207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010181674Medicaid
067T0OtherBLUE CROSS BLUE SHIELD NC
082480OtherBLUE CROSS BLUE SHIELD VA
251490OtherMAMSI/MDIPA
NC89067A7Medicaid
95343OtherOPTIMA
3900570OtherOPTIMUM CHOICE
P00237810OtherMEDICARE RAILROAD
P00237810OtherMEDICARE RAILROAD
067T0OtherBLUE CROSS BLUE SHIELD NC