| Doctor Name: | DR. MIGUEL MATOS |
| NPI Number: | 1790920775 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DO, MBA, MHA, MS |
| License Number: | OT012535 |
| Business Practice Address: | 1201 Washington St E Ste 208 Charleston, WV - 253011841 |
| Business Phone Number: | 3043887270 |
| Business Fax Number: | |
| Mailing Address: | 3110 Maccorkle Ave Se, CHARLESTON |
| State: | WV |
| Postal Code: | 253041210 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 12/04/2008 |
| NPI Last Update Date: | 10/28/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | OT012535 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | PA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |