Active NPI
Martin Dale Mathis
- Driver
- Stafford, VA
National Provider Identifier
1336878131
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Driver
- License
- B69620707
- Practice address
- 82 State Shop Rd
Stafford, VA 22554-7322 - Phone
- (540) 538-4973
- NPI assigned
- Jun 7, 2022
- Last updated
- Jun 7, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Driver | 172A00000X | B69620707 | VA | Primary |
Addresses
Primary practice location
82 State Shop Rd
Stafford, VA 22554-7322
Mailing address
82 State Shop Rd
Stafford, VA 22554-7322
Phone (540) 538-4973
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| B69620707 | VA | MD | Driver |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1654560000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1654560000000",
"number": "1336878131",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "82 STATE SHOP RD",
"city": "STAFFORD",
"state": "VA",
"postal_code": "225547322",
"telephone_number": "540-538-4973"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "82 STATE SHOP RD",
"city": "STAFFORD",
"state": "VA",
"postal_code": "225547322",
"telephone_number": "540-538-4973"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATHIS",
"first_name": "MARTIN",
"middle_name": "DALE",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-06-07",
"last_updated": "2022-06-07",
"certification_date": "2022-05-08",
"status": "A"
},
"taxonomies": [
{
"code": "172A00000X",
"taxonomy_group": "",
"desc": "Driver",
"state": "VA",
"license": "B69620707",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stafford, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.