Active NPI
Matthew T Olson
- Clinical Pathology/Laboratory Medicine Physician
- Jacksonville, FL
National Provider Identifier
1942460662
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Pathology/Laboratory Medicine Physician
- License
- ME132667
- Practice address
- 4500 San Pablo Rd S
Jacksonville, FL 32224-1865 - Phone
- (904) 953-2000
- NPI assigned
- Jun 16, 2008
- 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 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Pathology Physician | 207ZC0006X | D0074888 | MD | |
| Cytopathology Physician | 207ZC0500X | D0074888 | MD | |
| Anatomic Pathology Physician | 207ZP0101X | D0074888 | MD | |
| Clinical Pathology/Laboratory Medicine Physician | 207ZP0105X | ME132667 | FL | Primary |
Addresses
Primary practice location
4500 San Pablo Rd S
Jacksonville, FL 32224-1865
Mailing address
1210 Freeland Rd
Freeland, MD 21053-9563
Phone (443) 500-1253
Other practice location 1
86 Admiral Blvd
Dundalk, MD 21222-3946
Phone (918) 695-8985
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D0074888 | MD | MD | Clinical Pathology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1213574400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1521244800000",
"number": "1942460662",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1210 FREELAND RD",
"city": "FREELAND",
"state": "MD",
"postal_code": "210539563",
"telephone_number": "443-500-1253"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4500 SAN PABLO RD S",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322241865",
"telephone_number": "904-953-2000"
}
],
"practiceLocations": [
{
"address_1": "86 Admiral Blvd",
"address_purpose": "LOCATION",
"city": "Dundalk",
"state": "MD",
"postal_code": "212223946",
"country_code": "US",
"telephone_number": "918-695-8985",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "OLSON",
"first_name": "MATTHEW",
"middle_name": "T",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-06-16",
"last_updated": "2018-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "207ZC0006X",
"taxonomy_group": "",
"desc": "Pathology, Clinical Pathology",
"state": "MD",
"license": "D0074888",
"primary": false
},
{
"code": "207ZC0500X",
"taxonomy_group": "",
"desc": "Pathology, Cytopathology",
"state": "MD",
"license": "D0074888",
"primary": false
},
{
"code": "207ZP0101X",
"taxonomy_group": "",
"desc": "Pathology, Anatomic Pathology",
"state": "MD",
"license": "D0074888",
"primary": false
},
{
"code": "207ZP0105X",
"taxonomy_group": "",
"desc": "Pathology, Clinical Pathology/Laboratory Medicine",
"state": "FL",
"license": "ME132667",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.