Provider Demographics
NPI:1093826919
Name:KUBER, MATTHEW TIMOTHY (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:TIMOTHY
Last Name:KUBER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 SUNRISE AVE
Mailing Address - Street 2:
Mailing Address - City:HONESDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18431
Mailing Address - Country:US
Mailing Address - Phone:570-253-4255
Mailing Address - Fax:570-253-6844
Practice Address - Street 1:310 SUNRISE AVE
Practice Address - Street 2:
Practice Address - City:HONESDALE
Practice Address - State:PA
Practice Address - Zip Code:18431
Practice Address - Country:US
Practice Address - Phone:570-253-4255
Practice Address - Fax:570-253-6844
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD035300E207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010504730001Medicaid
PA0010504730001Medicaid
KU193066Medicare ID - Type Unspecified