Provider Demographics
NPI:1689623233
Name:MATTHEWS, WARREN BRUCE (MD)
Entity Type:Individual
Prefix:
First Name:WARREN
Middle Name:BRUCE
Last Name:MATTHEWS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8250 OLD YORK RD # 2
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-1514
Mailing Address - Country:US
Mailing Address - Phone:215-886-0440
Mailing Address - Fax:215-886-0477
Practice Address - Street 1:8250 OLD YORK RD # 2
Practice Address - Street 2:
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-1514
Practice Address - Country:US
Practice Address - Phone:215-886-0440
Practice Address - Fax:215-886-0477
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD020995E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA139200Medicare PIN