Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | SC007088 | PA |
NPI | 1063032019 |
---|---|
Provider Name | Dr. Matthew Augustus Pitre |
First Address | Scranton, PA 18510-2369 |
Second Address | Danville, PA 17822-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2020 |
Last Update Date | 19/08/2020 |