Provider Demographics
NPI:1679811103
Name:MAUST, MATTHEW KENNETH (PA)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:KENNETH
Last Name:MAUST
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Gender:M
Credentials:PA
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Mailing Address - Street 1:3737 MARKET ST
Mailing Address - Street 2:8TH FL
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-3340
Mailing Address - Country:US
Mailing Address - Phone:215-662-3340
Mailing Address - Fax:215-222-8878
Practice Address - Street 1:3737 MARKET ST FL 8
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-5545
Practice Address - Country:US
Practice Address - Phone:215-662-3340
Practice Address - Fax:215-222-8878
Is Sole Proprietor?:No
Enumeration Date:2013-01-17
Last Update Date:2022-07-21
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Provider Licenses
StateLicense IDTaxonomies
PAMA055948363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA20-1902674Medicare UPIN