Provider Demographics
NPI:1578550877
Name:SOWA, MATTHEW DAVID (DPM)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:DAVID
Last Name:SOWA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 LENHART RD
Mailing Address - Street 2:PO BOX 425
Mailing Address - City:FLEETWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19522-8613
Mailing Address - Country:US
Mailing Address - Phone:610-944-6537
Mailing Address - Fax:610-944-8152
Practice Address - Street 1:12 LENHART RD
Practice Address - Street 2:
Practice Address - City:FLEETWOOD
Practice Address - State:PA
Practice Address - Zip Code:19522-8613
Practice Address - Country:US
Practice Address - Phone:610-944-6537
Practice Address - Fax:610-944-8152
Is Sole Proprietor?:No
Enumeration Date:2005-10-02
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC-004634-L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001634338Medicaid
PA1627980OtherHIGHMARK BLUE SHIELD
PA50058771OtherCAPITAL BLUE CROSS
PA50058771OtherCAPITAL BLUE CROSS
PA001634338Medicaid