Provider Demographics
NPI:1679820583
Name:PERRY, MATTHEW GEORGE (PA-C)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:GEORGE
Last Name:PERRY
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 1:114 LT MICHAEL CLEARY DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:PA
Mailing Address - Zip Code:18612-1649
Mailing Address - Country:US
Mailing Address - Phone:570-574-8548
Mailing Address - Fax:
Practice Address - Street 1:114 LT MICHAEL CLEARY DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:PA
Practice Address - Zip Code:18612-1649
Practice Address - Country:US
Practice Address - Phone:570-574-8548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-09
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant