Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MD025314E | PA |
N | 111NI0900X | Internist | MD025314E | PA |
Y | 207RC0000X | Internist - Cardiovascular Disease | MD025314E | PA |
NPI | 1003839606 |
---|---|
Provider Name | Dr. Matthew Decaro |
First Address | Philadelphia, PA 19107-4216 |
Second Address | Philadelphia, PA 19107-4216 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 18/12/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001078607 | (05) | PA |
4515501 | (05) | NJ |