Provider Demographics
NPI:1730184425
Name:MATTERN, JOHN QA II (DO)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:QA
Last Name:MATTERN
Suffix:II
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:6350 CENTER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-4107
Mailing Address - Country:US
Mailing Address - Phone:757-213-5700
Mailing Address - Fax:757-213-5701
Practice Address - Street 1:1051 LOFTIS BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-3069
Practice Address - Country:US
Practice Address - Phone:757-873-9400
Practice Address - Fax:757-873-9420
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0102024256207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA110054750OtherRAILROAD MEDICARE
VA005808855Medicaid
VA55097OtherOPTIMA
VA005808855Medicaid
VA830003008Medicare PIN
VAB59968Medicare UPIN