Provider Demographics
NPI:1003843921
Name:BESHARA, MATHEW N (MD)
Entity Type:Individual
Prefix:
First Name:MATHEW
Middle Name:N
Last Name:BESHARA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3701 MARKET STREET
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104
Mailing Address - Country:US
Mailing Address - Phone:215-662-6035
Mailing Address - Fax:215-615-0574
Practice Address - Street 1:3400 SPRUCE STREET
Practice Address - Street 2:5 PENN TOWER
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104
Practice Address - Country:US
Practice Address - Phone:215-662-6035
Practice Address - Fax:215-349-5228
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2014-02-28
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Provider Licenses
StateLicense IDTaxonomies
PAMD072026L207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019065810001Medicaid
048606Medicare PIN
PA0019065810001Medicaid