Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | MD0395890 | PA |
NPI | 1063636694 |
---|---|
Provider Name | Anthony Matteo |
First Address | Horsham, PA 19044-2029 |
Second Address | Horsham, PA 19044-2029 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1174705 | CIGNA (01) | PA |
71693401 | UNITED (01) | PA |
C30746 | (02) | PA |