Provider Demographics
NPI:1679528400
Name:PROHASKA, MATTHEW GREGORY (DO)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:GREGORY
Last Name:PROHASKA
Suffix:
Gender:M
Credentials:DO
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Other - First Name:
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Mailing Address - Street 1:4330 COLLETTSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:COLLETTSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28611-9000
Mailing Address - Country:US
Mailing Address - Phone:828-754-2409
Mailing Address - Fax:828-754-2418
Practice Address - Street 1:4330 COLLETTSVILLE RD
Practice Address - Street 2:
Practice Address - City:COLLETTSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28611-9000
Practice Address - Country:US
Practice Address - Phone:828-754-2409
Practice Address - Fax:828-754-2418
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA024859207Q00000X
NC2016-02370207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine