Basic Information
Provider Information
NPI: 1538140314
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DOWS
FirstName: MATTHEW
MiddleName: M
NamePrefix: MR.
NameSuffix:  
Credential: P.A.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2140 FISHER RD
Address2:  
City: MECHANICSBURG
State: PA
PostalCode: 170555122
CountryCode: US
TelephoneNumber: 7177661795
FaxNumber: 7176976575
Practice Location
Address1: 2140 FISHER RD
Address2:  
City: MECHANICSBURG
State: PA
PostalCode: 170555122
CountryCode: US
TelephoneNumber: 7177661795
FaxNumber: 7176976575
Other Information
ProviderEnumerationDate: 11/09/2005
LastUpdateDate: 01/23/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363AM0700XMA054741PAY Physician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
363AM0700XOA002583PAN Physician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical

No ID Information.


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