Basic Information
| Provider Information | |||||||||
| NPI: | 1619331873 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | SPIVEY | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 130 MASON FARM ROAD | ||||||||
| Address2: | CAMPUS BOX 7055 | ||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275997055 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199669166 | ||||||||
| FaxNumber: | 9199666730 | ||||||||
| Practice Location | |||||||||
| Address1: | 102 MASON FARM ROAD | ||||||||
| Address2: | SECOND FLOOR | ||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275997745 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199669166 | ||||||||
| FaxNumber: | 9199666730 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2016 | ||||||||
| LastUpdateDate: | 06/28/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XX0005X | 2022-01290 | NC | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207X00000X | 2022-01290 | NC | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.