Provider Demographics
NPI:1437397007
Name:TRUSCELLO, MATTHEW DAVID (DPM)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:DAVID
Last Name:TRUSCELLO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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Mailing Address - Street 1:647 DUNLOP LN
Mailing Address - Street 2:209
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-5165
Mailing Address - Country:US
Mailing Address - Phone:931-245-1920
Mailing Address - Fax:931-245-1929
Practice Address - Street 1:647 DUNLOP LN
Practice Address - Street 2:209
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-5165
Practice Address - Country:US
Practice Address - Phone:931-245-1920
Practice Address - Fax:931-245-1929
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-04
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY00359213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery