Provider Demographics
NPI:1629005046
Name:MATHEWS, ROBERT SIMON (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:SIMON
Last Name:MATHEWS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 GOOD DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-2390
Mailing Address - Country:US
Mailing Address - Phone:717-940-1737
Mailing Address - Fax:
Practice Address - Street 1:1300 MILLERSVILLE PIKE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-6614
Practice Address - Country:US
Practice Address - Phone:717-299-3524
Practice Address - Fax:717-299-3552
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD014585E207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA142692MKAMedicare PIN
PAC31644Medicare UPIN