Provider Demographics
NPI:1790749646
Name:KLINE, MATTHEW T (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:T
Last Name:KLINE
Suffix:
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:P.O. BOX 12870
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19850-2870
Mailing Address - Country:US
Mailing Address - Phone:800-526-3536
Mailing Address - Fax:302-733-0854
Practice Address - Street 1:101 S BRYN MAWR AVE
Practice Address - Street 2:STE 200
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3123
Practice Address - Country:US
Practice Address - Phone:610-527-9500
Practice Address - Fax:610-527-8166
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-15
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD029145E207LP2900X
DEC1-0006716207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001049552Medicaid
PAP00972273OtherRAILROAD MEDICARE
PA5658052OtherAETNA
PAC34318Medicare UPIN
PA5658052OtherAETNA