Provider Demographics
NPI:1669460333
Name:MATTHEWS, TED A JR (MD)
Entity Type:Individual
Prefix:
First Name:TED
Middle Name:A
Last Name:MATTHEWS
Suffix:JR
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 1:100 EXCELA HEALTH DR # 202
Mailing Address - Street 2:
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-9001
Mailing Address - Country:US
Mailing Address - Phone:724-537-7100
Mailing Address - Fax:724-537-9847
Practice Address - Street 1:100 EXCELA HEALTH DR STE 202
Practice Address - Street 2:
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650-9001
Practice Address - Country:US
Practice Address - Phone:724-537-7100
Practice Address - Fax:724-537-9847
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD036935E208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012071600004Medicaid
PA607814Medicare PIN
PAE53329Medicare UPIN
PA1660124OtherUPMC
PA1001157OtherGATEWAY
PA1406484OtherUMWA
PA60366OtherMEDPLUS
PA0012071600004Medicaid
PA020047087OtherRAILROAD MEDICARE
PA125682OtherHEATH AMERICA/ASSURANCE
PA607814Medicare PIN