Provider Demographics
NPI:1659303741
Name:CLARK, MATHEW M (MD)
Entity Type:Individual
Prefix:DR
First Name:MATHEW
Middle Name:M
Last Name:CLARK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:500 YORK RD
Mailing Address - Street 2:STE 108
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-2852
Mailing Address - Country:US
Mailing Address - Phone:215-481-2725
Mailing Address - Fax:215-481-3013
Practice Address - Street 1:500 YORK RD
Practice Address - Street 2:SUITE #108
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-2852
Practice Address - Country:US
Practice Address - Phone:215-481-2725
Practice Address - Fax:215-481-3013
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2014-07-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD037255E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1073567Medicaid
PA1073567Medicaid
PA043295Medicare PIN