Provider Demographics
NPI:1407997562
Name:TONIATTI, MATTHEW PAUL (PA-C)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:PAUL
Last Name:TONIATTI
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 1:155 E BENNETT ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-4940
Mailing Address - Country:US
Mailing Address - Phone:570-283-5611
Mailing Address - Fax:
Practice Address - Street 1:1 KACEY CT
Practice Address - Street 2:SUITE 101
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17055-9223
Practice Address - Country:US
Practice Address - Phone:717-591-0961
Practice Address - Fax:717-591-0980
Is Sole Proprietor?:No
Enumeration Date:2007-02-10
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA002957L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA198927ZA9KOtherMEDICARE PTAN
PAP03250Medicare UPIN