Basic Information
| Provider Information | |||||||||
| NPI: | 1730307976 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MATTHEWS | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | T | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1803 MOUNT ROSE AVE | ||||||||
| Address2: | STE B3 | ||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174033026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178511405 | ||||||||
| FaxNumber: | 7178516969 | ||||||||
| Practice Location | |||||||||
| Address1: | 2250 E MARKET ST | ||||||||
| Address2: | STE E | ||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174022857 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178511566 | ||||||||
| FaxNumber: | 7178123950 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2007 | ||||||||
| LastUpdateDate: | 07/21/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD016910E | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 150973 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 50070353 | 01 | PA | CAPITAL BLUE CROSS-WMG | OTHER | 897637 | 01 | MD | CAREFIRST MD BCBS | OTHER | 211140 | 01 | PA | UNISON-WMG | OTHER | 2161250 | 01 | PA | MAMSI-WMG | OTHER | 20061853 | 01 | PA | AMERIHEALTH MERCY-WMG | OTHER | P000307 | 01 | PA | GATEWAY-WMG | OTHER | 109230 | 01 | PA | GEISINGER | OTHER | 210473 | 01 | PA | JOHNS HOPKINS | OTHER | 4027998 | 01 | PA | AETNA | OTHER | 50084010 | 01 | PA | CAPITAL BLUE CROSS-WMG THFP | OTHER | 000737760 | 05 | PA | MEDICAID | 20090052 | 01 | PA | AMERIHEALTH MERCY | OTHER | 263726 | 01 | PA | UNISON-WMG THFP | OTHER |