Provider Demographics
NPI:1407331911
Name:FORSYTHE, MATTHEW B (CRNP)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:B
Last Name:FORSYTHE
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5360 LINCOLN HWY
Mailing Address - Street 2:STE 15
Mailing Address - City:GAP
Mailing Address - State:PA
Mailing Address - Zip Code:17527-9451
Mailing Address - Country:US
Mailing Address - Phone:717-442-8111
Mailing Address - Fax:
Practice Address - Street 1:5360 LINCOLN HWY
Practice Address - Street 2:STE 15
Practice Address - City:GAP
Practice Address - State:PA
Practice Address - Zip Code:17527-9451
Practice Address - Country:US
Practice Address - Phone:717-442-8111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-01
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP019267363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily