Provider Demographics
NPI:1992792683
Name:CERNY, MATTHEW J JR (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:J
Last Name:CERNY
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 678904
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-8904
Mailing Address - Country:US
Mailing Address - Phone:800-841-4236
Mailing Address - Fax:843-497-8566
Practice Address - Street 1:300 SINGLETON RIDGE RD
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-9142
Practice Address - Country:US
Practice Address - Phone:843-347-7111
Practice Address - Fax:843-497-9566
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC106122085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC21978OtherMEDCOST
NC7905421OtherNC MEDICAID
SC106129Medicaid
SC154758900OtherFEDERAL BLACK LUNG
SC570525838OtherSTANDARD TAX ID
SC300085525OtherRAILROAD MEDICARE
NC05421OtherBCBS OF NC
SC154758900OtherUS DEPT OF LABOR
SC570525838OtherSTANDARD TAX ID
NC05421OtherBCBS OF NC