Provider Demographics
NPI:1073848578
Name:MCRAE, MATTHEW THOMAS
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:THOMAS
Last Name:MCRAE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2209 QUARRY DR.
Mailing Address - Street 2:SUITE B-23
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19609
Mailing Address - Country:US
Mailing Address - Phone:610-678-9949
Mailing Address - Fax:610-678-9636
Practice Address - Street 1:2209 QUARRY DR.
Practice Address - Street 2:SUITE B-23
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19609
Practice Address - Country:US
Practice Address - Phone:610-678-9949
Practice Address - Fax:610-678-9636
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-16
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA03956808601968171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA076441Medicare UPIN