Provider Demographics
NPI:1285655043
Name:FORJOHN, MATTHEW A (PA-C)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:A
Last Name:FORJOHN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 SUMNEYTOWN PIKE STE 210
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-5390
Mailing Address - Country:US
Mailing Address - Phone:215-257-5071
Mailing Address - Fax:215-257-1801
Practice Address - Street 1:815 SUMNEYTOWN PIKE STE 210
Practice Address - Street 2:
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-5390
Practice Address - Country:US
Practice Address - Phone:215-257-5071
Practice Address - Fax:215-257-1801
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA051616363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
078923LUBMedicare ID - Type Unspecified
Q15626Medicare UPIN