Provider Demographics
NPI:1639129968
Name:DELANEY, MATTHEW F (PA-C)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:F
Last Name:DELANEY
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 1:10 ARNHEM WAY
Mailing Address - Street 2:
Mailing Address - City:FORT LIBERTY
Mailing Address - State:NC
Mailing Address - Zip Code:28307-6149
Mailing Address - Country:US
Mailing Address - Phone:910-978-0541
Mailing Address - Fax:448-333-3489
Practice Address - Street 1:2817 ROCK MERRITT AVENUE
Practice Address - Street 2:
Practice Address - City:FORT LIBERTY
Practice Address - State:NC
Practice Address - Zip Code:28310-4504
Practice Address - Country:US
Practice Address - Phone:910-907-6000
Practice Address - Fax:448-333-3489
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9104101363A00000X
NC0010-11776363A00000X, 171000000X
FLPA9104101363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL292751900Medicaid
FL292751900Medicaid
P00661922Medicare PIN