Provider Demographics
NPI:1699663971
Name:MACLARTY, MATTHEW KELLER (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:KELLER
Last Name:MACLARTY
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:POTSDAM
Mailing Address - State:NY
Mailing Address - Zip Code:13676-2123
Mailing Address - Country:US
Mailing Address - Phone:315-268-2161
Mailing Address - Fax:
Practice Address - Street 1:59 MAIN ST
Practice Address - Street 2:
Practice Address - City:POTSDAM
Practice Address - State:NY
Practice Address - Zip Code:13676-2123
Practice Address - Country:US
Practice Address - Phone:315-268-2161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-25
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9120407208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice